Adapted

Aquatics
Programming
A Professional Guide
second
edition

Monica Lepore, EdD

West Chester University of Pennsylvania

G. William Gayle, PhD

Wright State University

Shawn Stevens, EdD

Edgemoor Community Center

Note: This e-book reproduces the text of the printed book,

but it may not include images, tables, or figures that
have restrictions on electronic distribution.

Human Kinetics
 Library of Congress Cataloging-in-Publication Data
Lepore, Monica, 1956-
  Adapted aquatics programming : a professional guide / Monica Lepore, G. William Gayle,
Shawn Stevens. -- 2nd ed.
     p. cm.
  Includes bibliographical references and index.
  ISBN-13: 978-0-7360-5730-1 (hard cover)
  ISBN-10: 0-7360-5730-7 (hard cover)
  1. Swimming for people with disabilities. 2. Aquatic exercises--Therapeutic use. 3. People with disabilities--Rehabilitation.
I. Gayle, G. William. II. Stevens, Shawn F., 1956- III. Title.
  GV837.4.L47 2007
  797.2’1087--dc22 2006101439
ISBN-10: 0-7360-5730-7 (print) ISBN-10: 0-7360-8586-6 (Adobe PDF)
ISBN-13: 978-0-7360-5730-1 (print) ISBN-13: 978-0-7360-8586-1 (Adobe PDF)
Copyright © 2007, 1998 by Monica Lepore, G. William Gayle, and Shawn Stevens
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This book is dedicated to our families and to the thousands of individuals with disabilities
from whom we learned the skills included in this book.
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Science. Contents
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Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Part I Foundations of Adapted Aquatics 1

Chapter 1 Introduction to Adapted Aquatics . . . . . . . . . . . . . . . . . . . . . . 3

Evolution of Adapted Aquatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Legislation for Individuals With Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Benefits of Aquatics Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Applications of Aquatics Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Chapter 1 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Chapter 2 Models of Collaboration in Adapted Aquatics . . . . . . . . . . 21

Models for Adapted Aquatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Medical-Therapeutic Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Educational Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Recreation Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Transdisciplinary Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Chapter 2 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Chapter 3 Inclusion and the Least-Restrictive Environment . . . . . . . . . 39

Placement, Inclusion, and the LRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Continuum of Placements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Prerequisites to Successful Inclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Developing and Maintaining Successful Inclusion Groups . . . . . . . . . . . . . . 52
Using Activities to Facilitate Inclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Chapter 3 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Chapter 4 Individualized Instructional Planning . . . . . . . . . . . . . . . . . . 67

Planning for Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Developing the IEP or IAPP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Implementing the IEP or IAPP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Chapter 4 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Chapter 5 Program and Organization Development . . . . . . . . . . . . . . 85

Organizational Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Communications and Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91


vi Contents

Financial Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Facilities Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Risk Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Program Development and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Human Resource Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Chapter 5 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Chapter 6 Facilities, Equipment, and Supplies . . . . . . . . . . . . . . . . . . . 107

Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Equipment and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Chapter 6 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Part II Facilitating Instruction 127

Chapter 7 Prerequisites to Safe, Successful,

and Rewarding Programs . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Essential Communication Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Transferring Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Participant Care and Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Hydrodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Positioning and Supporting Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Chapter 7 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

Chapter 8 Instructional Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

The Learning Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Teaching, Facilitating, and Guiding Participants . . . . . . . . . . . . . . . . . . . . . 168
Addressing Problem Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Chapter 8 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Chapter 9 Specific Needs of Adapted Aquatics Participants . . . . . . 189

Definitions of Common Disabilities in Adapted Aquatics . . . . . . . . . . . . . . .190
Commonly Seen Attributes of Learners in Adapted Aquatics . . . . . . . . . . 193
Atlantoaxial Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Attention Deficit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Auditory Perception Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Autonomic Dysreflexia or Hyperreflexia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Balance Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Brittle Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
Cardiovascular Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Circulatory Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Contractures and Limitations to Range of Motion . . . . . . . . . . . . . . . . . . . . 200
Hearing Loss: Deafness and Hard of Hearing . . . . . . . . . . . . . . . . . . . . . . . . 202
Hearing Loss: Deafblindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Head Control Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
High Muscle Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Hyperactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Interaction Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Joint Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Kinesthetic System Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Memory and Understanding Difficulty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Multisensory Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Oral Motor Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
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the source of English Paralysis, Paresis, and Atrophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

eBooks in Physical Posture Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Primitive Reflex Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
216
217

Education & Sports Proprioceptive Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Range of Motion Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
218
218

Science. Receptive or Expressive Language Disorder . . . . . . . . . . . . . . . . . . . . . . . . .

Respiratory Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
218
219
Seizure Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Tactile System Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Temperature Regulation Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
https://telegram.me/Li Vestibular System Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Visual Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
222
223
bExPh Visual Perception Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
225
226
Chapter 9 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

Chapter 10 Aquatic Fitness and Rehabilitation . . . . . . . . . . . . . . . . . . . 229

Health-Related Physical Fitness and Aquatic Exercise . . . . . . . . . . . . . . . . . 231
Physical Conditions and Tips for Aquatic Rehabilitation . . . . . . . . . . . . . . . 240
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Chapter 10 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

Part III Program Enhancement 245

Chapter 11 Adapted Aquatics Program Selection . . . . . . . . . . . . . . . . 247

Program Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Program Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Types of Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Nationally Sponsored Adapted Aquatics Programs . . . . . . . . . . . . . . . . . . . 255
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Chapter 11 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

Chapter 12 Competitive and Recreational Activities . . . . . . . . . . . . . . 261

Effect of Legislation on Aquatics Participation . . . . . . . . . . . . . . . . . . . . . . . 262
Competitive Swimming for Individuals With Disabilities . . . . . . . . . . . . . . . . 263
Equitable Competition and Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Coaching Swimmers With Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Recreational Aquatic Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Chapter 12 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280

Appendix A Adapted Aquatics Position Paper of the Aquatic Council:

AAALF and AAHPERD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Appendix B Assessment Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Appendix C Games and Activities for Various Age Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Appendix D Information-Gathering Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Appendix E Adapted Aquatics Program Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Appendix F AAPAR Levels of Adapted Aquatics Credentials . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
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Welcome to the second edition of Adapted Aquatics
Programming: A Professional Guide. This text is designed
for people seeking information on the empowerment
and self-actualization of individuals with disabilities
through swimming and related aquatic activities. It is
intended for university students studying recreation,
general or adapted physical education, special edu-
cation, therapeutic recreation, or related allied health
fields. This book supplies aquatics professionals the
necessary information for providing safe, effective,
and successful aquatics participation to individuals
requiring adaptations to environment, equipment,
instructional strategies, skill techniques, and teaching
methods. These adaptations may be necessary due to
variations in emotional, cognitive, or physical abili-
ties. This book does not substitute for basic aquatics
instructor credentials, nor does it replace instructor
credentials in adapted aquatics. At the time of pub-
lishing, it is the required text for the two adapted
aquatics instructor credentials in the United States: the
AAHPERD/AAPAR Adapted Aquatics Instructor and
the YMCA Swim Lesson Instructor—Individuals with
Disabilities. It is also a reference for all pool operators
concerned with best practices for adapted aquatics,
and it complements the DVD Introduction to Adapted
Aquatics by Sprint Aquatics.
This book was conceptualized in the late 1990s in
response to the American Red Cross disbanding its
national Adapted Aquatics Instructor program, thus
eliminating future editions of its 1977 textbook. In
addition, following the 1989 Canadian Red Cross
publication Adapted Aquatics: Promoting Aquatic
Opportunities for All and the 1994 AAHPERD pub-
lication by Carter, Dolan, and LeConey entitled
Designing Instructional Swim Programs for Individuals
with Disabilities, further editions did not develop. This
created a void in professional literature regarding best
practices in adapted aquatics and led to the 1998 first
edition of Adapted Aquatics Programming: A Profes-
sional Guide. Following 5 successful years with the
book, we and Human Kinetics reconceptualized the
textbook, adding information containing legislation,
Preface
instructional strategies, equipment, photographs,
and competitive and recreational aquatics activities.
Publication of this updated text will fill the market
void for a source of current best practices in adapted
aquatics programming. We hope you find this second
edition to be a valuable resource.
This edition of Adapted Aquatics Programming is
a significant addition to the aquatics literature. It is a
comprehensive resource and learning tool for the field
of aquatics. Approximately 50% rewritten from the first
edition, it includes a plethora of references, practical
pointers, background and history facts, teaching tips,
safety precautions, and administrative information.
Updates include relevant legislation, architectural
accessibility guidelines, competition information,
instructional strategies, and safety management. This
edition contains administrative best practices promot-
ing current thinking on inclusion in physical activ-
ity. It also includes basic skills for adapted aquatics
instructors and instructional strategies, methods, and
adaptations. Administration, risk management, and
human resource materials are studied, as are adapted
aquatics programs. Competitive, recreational, fitness,
and other enrichment uses of aquatics are illustrated
for individuals with disabilities.
This book is based on practical, action-based
research and on current thinking, laws, and practices.
As such, it is a practical approach to adapted aquat-
ics information. In addition to the chapter-opening
scenarios, each section provides specific techniques
as well as rationales for adapted aquatics program-
ming. Practical information is infused throughout
each chapter. We have based the information in this
book on applied successful techniques accumulated
over decades of experience in aquatics pedagogy.
Organization
Adapted Aquatics Programming begins with a brief
history of adapted aquatics, tracing its development
from its roots with therapeutic modalities and the
ix
 Preface
allied health and exercise sciences through its matu-
ration toward an instructional and recreational view-
point. The book then examines legislation affecting
participation in aquatics education and aquatics rec-
reation for individuals with disabilities. The chapters
that follow introduce you to today’s field of adapted
aquatics and then describe tools needed to provide
quality instruction. Final chapters supply enrichment
information to help you improve programs and refer
swimmers to opportunities beyond the instructional
realm.
This book is divided into 12 chapters organized
into three parts. Part I, Foundations of Adapted Aquat-
ics, covers the basics of adapted aquatics. Chapter
1 looks at the history of various health and exercise
organizations and their roles in the development of
what we now know as adapted aquatics. Terms and
phrases related to adapted aquatics are defined and
the various disciplines using adapted aquatics are
described. Chapter 2 examines models of service,
highlighting the medical-therapeutic, education,
recreation, and transdisciplinary models. Chapter 3
explores inclusion and the least-restrictive environ-
ment as educational concepts that can relate to life-
span programming. Chapter 4 delves into the how-tos
of individualized instructional planning for adapted
aquatics. Chapter 5 reveals the importance of program
and organizational development for the adapted
aquatics administrator, discussing risk management,
strategic planning, financial development, and human
resources. Chapter 6 finishes part I with a practical
look at facilities, equipment, and supplies—essential
components of an adapted aquatics program.
Part II of this text, Facilitating Instruction, builds
on the basic knowledge of part I and focuses on the
teaching of adapted aquatics. Chapter 7 introduces
prerequisite skills that adapted aquatics instructors
must possess, including communication, physical
assistance, transferring techniques, and participant
care and safety. Chapter 8 discusses the learning pro-
cess, the selection of appropriate instructional strate-
gies, teaching cues, and adapted stroke techniques,
as well as strategies to address behavior problems of
some individuals with disabilities. Chapter 9 concen-
trates on the unique attributes that swimmers with dis-
abilities are most likely to possess that need attention
from an adapted aquatics instructor. Lastly, chapter
10 addresses fitness aspects of adapted aquatics pro-
grams from a health-related fitness approach.
Part III, Program Enhancement, rounds out the
book by discussing adapted aquatics program selec-
tion and adapted aquatics opportunities beyond the
pool. Chapter 11 focuses on real-life adapted aquat-
ics settings, exploring community-based, residential,
hospital-based or therapeutic, and school-based
programs. Chapter 12 introduces competitive swim-
ming for individuals with disabilities and describes
the national and international sport organizations
sponsoring the competitions. This final chapter ends
with a discussion on recreational aquatic activities,
including waterskiing, scuba diving, and boating,
addressing both equipment and performance tech-
niques.
As you read the text, you will discover that it
approaches adapted aquatics from a noncategorical
viewpoint. In other words, it is not organized in such a
way that you can use it to look up a disability category
and find magical, all-inclusive solutions for working
with a particular disability. Rather, chapters 8 and 9
describe the typical attributes making each disability
unique. You may then draw upon that knowledge to
review issues that a swimmer with specific charac-
teristics may face in the aquatic setting.
Features
This second edition of Adapted Aquatics Program-
ming provides new features, including scenarios that
introduce each chapter, chapter objectives, up-to-
date photos and diagrams, updated references and
resources, additional stroke adaptations, inclusionary
principles, and current information on accessibility of
pools and spas. None of these features was available
in the previous edition.
Preservice preprofessionals will find the life-
experience scenarios a great way to begin each
chapter. These practical examples will help them
engage with the material by providing a reference
point for the text ahead. The chapter objectives list
major tenets and provide an overview of what is to
be learned from the chapter. Preprofessionals and
professionals in allied fields (occupational or physical
therapy, kinesiotherapy, aquatics instruction, man-
agement, or coaching) will find materials in this text
to supplement existing academic and experiential
aquatics backgrounds.
Another unique feature of this book is its more
than 100 photos, diagrams, and drawings that bring
its words to life. The photos demonstrate the points
made in the text and pull the reader into the written
word, illustrating concepts in a manner that words
alone cannot.
Finally, the appendixes at the end of this book
support the materials in the chapters in a practical
manner. Forms, games, and lists of resources provide
direct links between the materials in the chapters and
the transition to the day-to-day working of adapted
aquatics programs.
 Acknowledgments
Thank you to Melissa Feld, Martha Gullo, and Amy
Tocco at Human Kinetics.
Thank you to Christine Stopka for her informative
and thorough review of this book, and to all of our
anonymous reviewers for their recommendations.
Thank you to the AAHPERD/AAPAR Master Teach-
ers of Adapted Aquatics for their suggestions to the
second edition.
Thank you to Marsha K. Mazz, senior accessibil-
ity specialist, technical assistance coordinator, U.S.
Access Board, for information related to ADA swim-
ming pool accessibility guidelines.
Thank you to Dave Lenox, Ryan Murphy, and Doug
McAllister for contributing to the Special Olympics
sections of this text.
Thank you to Deborah Hertz of the NMSS and Kate
Cowperthwait, president of the Delaware chapter of
the NMSS, for input into the sections on multiple
sclerosis and aquatics.
Thank you to Ellen Caruso for information on the
Aquatic Physical Therapy Section of the American
Physical Therapy Association.
Thank you to Mary Essert, Grace Reynolds, Jerald
Jordan, J. Gunderson, Jerry McCole, Pam Danberg,
Mark Lucas, Dennis Runyan, Reed Gershwind, and
Bobbie Beth Scoggins, EdD, president of the USADSF,
for their help with the history of adapted aquatics and
competitive aquatics for people with disabilities.
Thank you to the staff at the following organiza-
tions for their assistance with the photo shoot: Rocky
Run YMCA, Media, Pennsylvania; the Jewish Commu-
nity Center of Wilmington, Delaware; and the Mary
Campbell Center, Wilmington, Delaware.
Thank you to Gail Dummer of Michigan State
University for her contributions to competitive and
recreational swimming information.
Thank you to Andrew Alderfer; Tim and Colleen
Hoge; Josh Lorello; Elizabeth Nolan; Olivia and Ian
Riehl; Michael, Maggie, Danny, and Bridgett Malloy;
Lily and Nate Seagraves; Jack VanWinkle; Cici and
Jared Cosier; and all the families in the West Chester
University Adapted Physical Activities Program for
participating in the photo shoot.
Thank you to Sharna Shuford, Justin Westmorland,
Michelle Hands, and Paul Dietrich for their assistance
with photographs.
Thank you to Mark and Doris Anderman of The
Wild Studio photographers.
Thank you to Maria Lepore-Stevens for her support
and creativity during the writing of this book and as
a helper at the various photo shoots.
Thank you to the DeBenny family for the use of
their pool and their support for the photos in this
book.
Thank you to the duPont Hospital for Children,
Wilmington, Delaware, for their assessment and
referral forms.
Thank you to the athletes, staff, and volunteers at
all the Camp Abilities Sports Camps in Alaska, Ari-
zona, New York, Pennsylvania, and Puerto Rico for
the creative ideas they have shared and the photos
they provided.
Thank you to Lauren Lieberman, Katrina Arndt,
Paxton Copp, Amanda Tepfer, Megan O’Connoll,
Jeanine Fittapaldi-Wert, Alisa Carrozza, Leah
Posocco, Beth Foster, Kat Ellis, Gina Pucci, Dani
Laroux, Gwen Schnabel, Heidi Rollheiser, Ibra Cor-
daro, and Margarita Fernandez for their support in
sharing sports camp materials and life lessons.
Thank you to Pat, Frank, Anne, Donna, and DJ for
their support during this book process.
xi
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 Part I

Foundations
of Adapted
Aquatics


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 1
Introduction to
Adapted Aquatics

M egan is a 10-year-old girl who requires maximum physical assistance to

participate in her land-based physical education class. Because of her
lack of ability and voluntary movement on land, Megan’s caregivers believe that
Megan needs other forms of activity in order to achieve the benefits of physical
fitness. They have asked the school district for a physical education assessment
to determine if Megan is making progress in her land-based physical education
class. Her caregivers have noticed that Megan exhibits the most independence
when placed in a flotation device in her community pool. Therefore, they have
asked that the assessment include a swimming component.
During the land portion of the physical education assessment, Megan was
unable to participate in physical activities without adult intervention. She was
not able to consistently perform voluntary movements against gravity or raise
her heart rate unless physically assisted. In contrast, during the pool assessment,
by using a head/neck flotation device Megan was able to raise her heart rate
by 40 beats per minute without teacher intervention. In addition, she continually
moved her arms and legs for 9 minutes without prompting.
Because of Megan’s performance during the aquatics assessment, Megan’s
individualized education planning committee decided that in addition to physi-
cal education instruction, Megan should receive adapted aquatics instruction
at the expense of the school district.


 Adapted Aquatics Programming

A dapted aquatics instruction is no longer the exclu-

sive business of camps, residential schools, and
after-school recreation programs. Adapted aquatics
Evolution of Adapted Aquatics

instruction can complement a land-based physical
activity program as well as stand alone as a valuable
part of physical education for K through 12 students
or as a physical activity program for adults and senior
citizens. Because of the physical support that water
provides, many people whose disability impairs
mobility on land can function more independently
in an aquatic environment, without the assistance of
braces, crutches, walkers, or wheelchairs. Indeed,
water is a medium that physically frees individuals
with disabilities, allowing them to safely and suc-
cessfully participate in physical activity. You can help
these individuals discover this freedom. Specifically,
by continuing your professional development you
will better understand the benefits of aquatics for
individuals with disabilities, the related federal legis-
lation mandates, and the need for positive community
attitudes toward the inclusion of individuals with dis-
abilities in aquatics. In this chapter, you’ll learn how
the field of adapted aquatics has evolved and about
the various U.S. agencies involved in aquatics pro-
grams for people with disabilities. In addition, you’ll
learn about the disability rights legislation that has
affected the aquatics industry, the benefits of instruc-
tional aquatics programs, and the various applications
of aquatics for people with disabilities.
Although aquatic participation for therapeutic pur-
poses has a long history, individuals with disabilities
have not always had full access to swimming and
water safety instruction for educational and leisure
purposes. Until recently, U.S. society and even pro-
fessionals working with individuals with disabilities
did not generally encourage such individuals to
participate in community aquatics due to numerous
barriers, including conflicting philosophies about
service delivery and professional responsibility. Water
provides a unique opportunity for developing physi-
cal and motor fitness, and aquatic opportunities have
expanded from passive, therapeutic programming
(see figure 1.1) to instructional swimming (see figure
1.2), recreational aquatics, and even international
competition.
Using water as a therapeutic tool predates all
other modalities of physical medicine, extending
back to ancient Mesopotamian, Egyptian, Indian,
and Chinese civilizations, who used the water for
soothing and healing purposes (De Vierville, 2004).
In later times, in Europe during the Middle Ages, large
healing pools and spas were built in such places as
Bath, England.

Chapter Objectives
From this chapter, you will learn the
following:
* Adapted aquatics has evolved from a
therapeutic modality to its current focus
on instruction, water safety, fitness, and
recreation.
* Several national organizations in the
United States provide aquatics programs
for people with disabilities.
* Federal legislation in the United States
Photo courtesy of Roosevelt Warm Springs

has affected the availability of aquatics

programs for people with disabilities.
* Participation in aquatic activities ben-
efits persons with disabilities physically,
socially, and emotionally.
* There are similarities and differences
among programs of adapted aquatics,
adapted water exercise, therapeutic
water exercise, aquatic therapy, and Figure 1.1  The medical-therapeutic model was a pre-
adapted swimming. cursor to instructional adapted aquatics.

Figure 1.2  Instructional adapted aquatics often consists of a small group working
on skills such as breath control.
Other European spas that focused on the healing
power of water were formed in the 19th century and
even today the science of aquatic therapy takes place
in spas such as Bad Ragaz in Switzerland. Many other
forms of treatment have come and gone, but the use
of water endures.
All over the world, people use swimming or
bathing in oceans, pools, lakes, rivers, and spas as
a means of relaxation, therapy, and learning. In the
United States, people with and without disabilities
flock to their local swim club for fun, exercise, and
social interaction.
The 21st century boasts approximately “360
million annual visits to recreational water venues”
(Centers for Disease Control and Prevention [CDC],
2003, p. 513) in the United States, and aquatics stands
as the second most popular recreational activity in
the United States.
The history of therapeutic aquatic activities in the
United States predates the New World settlers, with
Native Americans using hot and cold bathing plunges
as part of spiritual and medical regimes. Many years
later, Thomas Jefferson had a spa built around the nat-
ural warm springs in West Virginia. These early U.S.
experiences in natural mineral springs led the way
for more curiosity about the healing power of water,
and in the late 1800s and the early 1900s the first
U.S. medical standards for warm water therapeutics
were published by Simon Baruch. Other leaders in
hydrotherapy who emerged in the early 20th century
were such medical personnel as John Kellogg and
Guy Hinsdale (De Vierville, 2004).
Introduction to Adapted Aquatics 
Also in the early 1900s,
before World War I, Charles
Lowman, known as the father
of water exercise for therapeu-
tic purposes, began his work
in California with patients
with cerebral palsy, paralysis,
and infectious diseases. In the
1930s he systematized hydro-
therapy, which he defined
as the treatment of disease,
disability, and ill health using
water as the therapeutic
medium. Several years later,
during the post­–World War
II polio epidemic, physicians
realized the benefits of water
exercise for people with polio,
and this realization increased
the number and type of clien-
tele using water exercise for
rehabilitation. Unfortunately,
the public’s fear of people with
polio using community swimming pools (and possibly
spreading the virus through pool water) restricted
their aquatic rehabilitation programs to hospitals and
spas. As participation in water rehabilitation grew,
researchers carefully studied several programs and
concluded that water exercise had many benefits for
overall rehabilitation (Bryant, 1951).
At the same time, rehabilitation of soldiers and
civilians who were wounded during World War II
increased awareness of and demand for all types
of therapy, creating greater need for therapeutic
aquatic activities. Instructors were needed to con-
duct these programs and so the U.S. Armed Forces
initiated training programs for instructors, while
the American Red Cross (ARC) developed its own
programs. The growth of the medical uses of water
(hydrology, hydrotherapy) in addition to recreational,
instructional, and fitness uses prompted the forma-
tion of various aquatics programs. By the 1960s, the
separation between using water as therapy and using
it for people with disabilities in instructional and
recreational settings had officially begun. The early
efforts of using water for therapy that were made
by medical personnel led to many efforts toward
meeting the needs of individuals with disabilities,
including instructional, recreational, and competitive
programs created by the ARC, Young Men’s Christian
Association (YMCA), Special Olympics, National
Multiple Sclerosis Society (NMSS), Arthritis Foun-
dation, and American Alliance for Health, Physical
Education, Recreation and Dance (AAHPERD). The
therapy side of aquatics for people with disabilities
 Adapted Aquatics Programming
split into its use in physical and occupational therapy
and its use by allied health personnel credentialed
by nonmedical certifications such as the Interna-
tional Council for Aquatic Therapy and Rehabilita-
tion Industry Certification. In addition, the Aquatic
Therapy and Rehabilitation Institute became one of
the premier educational organizations for developing
aquatic therapy fitness professionals.
On the nontherapeutic side, in the 1970s the
efforts of the ARC, YMCA, and Special Olympics
turned aquatics for people with disabilities toward
instructional, recreational, and competitive uses.
The following sections provide a brief background
on U.S. organizations that in the second half of the
20th century (and in the early 21st century) affected
adapted aquatics. Some focused on instructional
adapted aquatics, some on water exercise, and some
on competitive opportunities.
Instructional and Recreational
Aquatics: American Red Cross
The ARC responded to World War II by developing its
Convalescent Swimming Program in the early 1940s.
This program offered swimming and water activities
that accommodated veterans with disabilities. In
1949, the ARC added a training course for instruc-
tors to ensure program quality (American Red Cross
[ARC], 1977). The program focused on adapting
swim strokes for persons with physical disabilities
such as amputations and paraplegia. The ARC revised
the program in 1955, renaming it Swimming for the
Handicapped.
In the 1970s, the ARC broadened the scope of
Swimming for the Handicapped and changed the
program content to include individuals with all
types of physical, mental, and emotional disabilities.
The expanded program was called Adapted Aquat-
ics. Louise Priest of the ARC national headquarters
developed the ARC Adapted Aquatics textbook in
1977, and through its local chapters, the ARC sup-
ported certifications for instructor trainers, instruc-
tors, and instructor aides. The ARC Adapted Aquatics
philosophy was couched in the idea that through
swimming and water safety instruction, individuals
with disabilities could experience the thrill of aquatic
activity while participating in programs available in
their communities.
The Adapted Aquatics programs and accompany-
ing instructor certification were widely taught until
the beginning of the 1990s, when the Red Cross
revamped its general Water Safety Instructor (WSI)
program to include information about individuals
with disabilities. Much of the WSI resource informa-
tion regarding adapted aquatics is contained in the
ARC text Swimming and Water Safety (2004a) and
in the Water Safety Instructor’s Manual (2004b).
Ultimately, the ARC embraced the philosophy of
including individuals with disabilities in general
aquatics programs and eliminated its segregated
Adapted Aquatics programs and certifications on the
national level.
Instructional and Recreational
Aquatics: Young Men’s Christian
Association
As Louise Priest pursued development of the ARC
Adapted Aquatics programs, Grace Demmery
Reynolds initiated similar efforts with the YMCA.
In 1960, the Longview, Washington, YMCA, now
the YMCA of Southwest Washington, published A
Swimming Program for the Handicapped. Written by
Reynolds and edited by Dallas and Esther Dedrick,
this manual was to become the framework for the
YMCA’s national adapted aquatics program during
the 1970s. Dallas Dedrick presented this manual
at the Pacific Northwest Area Council of YMCAs,
of which he was president, at the 1960 meeting in
Spokane, Washington. In 1968 and 1969, Reynolds,
then director of recreation for the handicapped at
the Longview, Washington, YMCA, represented the
YMCA on the committee of the Council for National
Cooperation in Aquatics (CNCA) and the American
Alliance for Health, Physical Education, and Recre-
ation (AAHPER) in the development of A Practical
Guide for Teaching the Mentally Retarded to Swim
(1969). In April 1970, Reynolds led a YMCA study
on its swimming programs for special populations.
Following Reynolds’ presentation of the results at
the 1970 YMCA National Aquatic Conference, the
national YMCA wrote proposals to develop training
materials, budgeting guidelines, safety standards,
personnel recruitment standards, record mainte-
nance guidelines, and skill progressions for aquatics
programs for persons with disabilities (Reynolds,
1973). In 1972, the YMCA introduced two levels
of certification. Aquatic Leader: Swimming for the
Handicapped was for assistant instructors, while
Instructor: Swimming for the Handicapped was for
people who planned and implemented adapted
aquatics programs. In later years these certifications
were called YMCA Aquatic Assistant and YMCA Spe-
cialist Instructor/Leader in Aquatics for Special Popu-
lations. Subsequently, the YMCA introduced a third
level of certification, Aquatic Director/Administrator
for Special Populations. In 1973, the national board
of YMCAs published a manual entitled A Swimming
Program for the Handicapped, which was edited by
Reynolds.
 Introduction to Adapted Aquatics 

From 1973 to 1982, Grace Demmery Reynolds
directed three special projects for the Bureau of Edu-
cation for the Handicapped: 1) Project Aquatics, 2)
Project Aquatics Mainstreaming, and 3) Project Main-
streaming Activities for Youth. These three projects
helped to disseminate training information to aquat-
ics instructors, recreational personnel, and national
youth agency leaders within the YMCA structures.
In 1987, YMCA of the USA copyrighted Aquatics for
Special Populations, which was published by Human
Kinetics and edited by Reynolds. Today, YMCA still
supports a certification titled Instructor: YMCA Swim
Lessons for Individuals With Disabilities.
Instructional and Recreational:
American Association for Physical
Activity and Recreation
The Council for Aquatic Professionals within the
American Association for Physical Activity and Rec-
reation (AAPAR) has four levels of credentials for
instructors in adapted aquatics: Master Teacher of
Adapted Aquatics (MTAA), Adapted Aquatics Instruc-
tor (AAI), Adapted Aquatics Adjunct (AAAdj), and
Adapted Aquatics Assistant (AAA). See chapter 11
and appendix F for more details on these credentials.
AAPAR is an association under the umbrella of the
American Alliance for Health, Physical Education,
Recreation and Dance, the largest organization for
health and physical education teachers in the United
States. AAHPERD (originally AAHPER) has advocated
for swimming for individuals with disabilities since
1969, when it published A Practical Guide for Teach-
ing the Mentally Retarded to Swim in cooperation
with the Council for National Cooperation in Aquatics
(Stein, 2002). In the 1960s and 70s, AAHPERD’s Unit
on Programs for the Handicapped and its Information
and Research Utilization Center, under the direction
of Julian Stein, produced many publications and
convened workshops and convention sessions regard-
ing swimming for persons with disabilities. In 1981,
under the guidance of Joan Moran and the Aquatic
Council, AAHPERD published Handicapped Swim-
ming: A Syllabus for the Aquatic Council’s Courses
Teacher and Master Teacher of Handicapped Swim-
ming. AAHPERD’s courses were professionally sound
appendix A), AAPAR and AAHPERD moved to the
forefront in adapted aquatics.
Aquatic Exercise:
Arthritis Foundation/
YMCA Aquatics Program
The Arthritis Foundation/YMCA Aquatics Program
(AFYAP) is a recreational exercise program designed
to promote range of motion, strength, endurance,
social interaction, independence, and pain manage-
ment in individuals with arthritis and other related
diseases. In 1974, Kit Wilson of the Whittier YMCA
in California developed a community-based arthritis
aquatics program called Twinges in the Hinges (YMCA
of the USA and the Arthritis Foundation, 1985) as a
collaborative venture with the Arthritis Foundation,
Southern California Chapter. Following this successful
program, a task force was implemented to combine
the best of the Whittier YMCA program with that of
three other successful arthritis exercise programs:
Keep Moving of Eugene, Oregon; Joint Efforts of Mil-
waukee, Wisconsin; and Rusty Hinges of Richport,
Illinois. In April 1983, the national YMCA and Arthritis
Aquatic Program Task Force met and approved a
nationwide program called the Arthritis Foundation/
YMCA Aquatics Program, which included set pro-
cedures for certifying leaders and instructors. Using
videotapes of approved exercises and an instructor
manual, AFYAP held the first instructor training work-
shop in October 1983. Since that time, the program
(figure 1.3) has expanded to include shallow water
Photo courtesy of Mapleton Center.

but not widely popular due to the ARC Adapted

Aquatics instructor courses being more readily avail-
able and more widely recognized. But as the ARC
phased out the national Adapted Aquatics instruc-
tor course in the early 1990s, the AAPAR (formerly
AAALF, American Association for Active Lifestyles and
Fitness)/AAHPERD instructor course was redesigned
and rolled out in 1993. With AAPAR’s course and
its position paper on adapted aquatics in 1996 (see Figure 1.3  An arthritis aquatics program in session.
 Adapted Aquatics Programming
exercises, a deep water program for adults, and, most
recently, an aquatic exercise program for children
with juvenile rheumatoid arthritis. Exercise sessions
include warm-up, flexibility, strength, and endurance
components as well as optional games and endurance
activities (Arthritis Foundation and the National Coun-
cil of YMCAs of the USA, 2002). Four main aquatic
exercise programs are offered: (1) the basic AFYAP,
(2) the plus AFYAP, (3) the deep water program, and
(4) the juvenile arthritis program.
Aquatic Exercise: National
Multiple Sclerosis Society
In 1991, in response to clients with multiple scle-
rosis (MS), the NMSS, Georgia Chapter, developed
a comprehensive aquatics program for community
facilities such as YMCAs, YWCAs, and private health
clubs (National Multiple Sclerosis Society [NMSS],
1993). The primary mission of the program is to
provide people with MS an opportunity to engage
in structured exercise after they are discharged from
formal physical therapy. The aquatic setting allows
participants to resume social activities within the
community following diagnosis or exacerbation
(flare-up). Persons conducting an MS aquatics pro-
gram must attend a 1-day MS aquatics training work-
shop for aquatics instructors. Course prerequisites
include CPR certification and ARC certification in
Community Water Safety, Water Safety Instructor, or
Lifeguard Training. Following successful completion
of this workshop, instructors receive a certificate of
attendance. The NMSS recommends that instructors
take a refresher course every 3 years.
Aquatic Exercise and Therapy:
Aquatic Exercise Association,
United States Water Fitness
Association, and Aquatic Therapy
and Rehabilitation Institute
As aquatic fitness continued to boom in the 1980s,
several professionals realized the need to organize
and unite the industry. The formation of the Aquatic
Exercise Association (AEA) in 1985 and its sponsor-
ship of the first international Aquatic Fitness Confer-
ence in 1988 led the way for the water fitness industry.
The AEA was founded by Ruth Sova and is now led
by Julie See and Angie Proctor. The AEA’s mission is
the growth and development of the aquatic fitness
industry. The AEA fulfills its mission by promoting
aquatic fitness instructor certification and numerous
continuing education programs throughout the world.
The AEA publishes AKWA, a magazine educating the
15,000 aquatic fitness professionals who subscribe.
The AEA recognizes the importance of aquatic fitness
for people with disabilities and actively encourages
colleagues to submit articles and conduct research
about aquatic fitness for various populations of people
with disabilities.
The United States Water Fitness Association
(USWFA) was founded in 1988 by John Spannuth
and Judge Robert Beach to promote water fitness
for all. The organization’s mission is the health and
safety of water fitness participants and instructors,
and USWFA offers several certifications such as Water
Fitness Instructor and Master Water Fitness Teacher,
Coordinator of Water Fitness Programs, Water-
Walking Instructor (two levels), Aquatic Director, and
Senior Aquatic Director. The organization promotes
water fitness programs, including adapted aquatics,
for people with disabilities.
The Aquatic Therapy and Rehabilitation Institute
(ATRI) is an organization dedicated to the educational
and professional development of health care provid-
ers in aquatic therapy (Aquatics International, 2003).
Founded by Ruth Sova in 1989, ATRI offers member-
ship and educational courses for aquatic therapists,
who may become certified though the International
Council for Aquatic Therapy and Rehabilitation
Industry Certification program (www.icatric.org). This
organization is indelibly linked to adapted aquatics,
as many of the courses are a natural extension for
adapted aquatics instructors, especially the Halliwick
method and the Bad Ragaz courses.
Competitive: Special Olympics
In 1968, the Special Olympics was founded to pro-
vide competitive sports events for individuals with
intellectual disabilities (see also chapters 11 and 12).
This organization has made tremendous strides in
making swimming programs accessible to the hun-
dreds of thousands of individuals with intellectual
disabilities in the United States and the world. The
first International Special Olympics Summer Games,
held in 1968, featured swimming as an official event
(Shriver, 1972). The Special Olympics provides sport
skill training and physical activity for individuals with
intellectual disabilities aged 6 and older and interna-
tional, national, and local competition for individuals
aged 8 and older. International, or World, Games are
offered every 2 years and alternate between winter
and summer sports. The international headquarters
provides training materials and sport development
guidance, while state programs offer training work-
shops for coaches and volunteers and offer competi-
tion on the state level. Local subprograms offer train-
ing and competition for athletes. Participation in the

Special Olympics aquatics programs has traditionally
been segregated, although an increasing number of
swimming programs have begun to utilize Special
Olympics training materials in order to include Spe-
cial Olympics athletes on their general swim teams
and in their training. Adult coaches enroll in Special
Olympics coaches training that includes three parts:
an introduction to Special Olympics coaching and
philosophy course, a specific sport training course,
and a 10-hour practicum. Coaching materials are
presented to each coach in training and are described
in chapter 11.
Competitive: Paralympics
The Paralympics are the equivalent of the Olympics
for people with disabilities and were first held in
Rome, Italy, in 1960. Swimming events have always
been a part of this international elite competition. The
first Paralympic World Swimming Championships
were held in Malta in November 1994. Although
aquatics as a Paralympic sport can hardly be called
adapted due to its elite nature and the fact that
scarcely any adaptations are needed, the Paralympic
sport organizations (PSOs) advocate, sponsor, and
organize competitive swimming events for people
with disabilities. More information is included on
such organizations in chapters 11 and 12.
U.S. organizations that participate in Paralympic
swimming events include the United States Asso-
ciation of Blind Athletes (USABA); Disabled Sports
USA (DS/USA); Wheelchair Sports, USA (WSUSA);
the National Disability Sports Alliance (NDSA); and
the Dwarf Athletic Association of America (DAAA).
U.S. athletes who belong to the USA Deaf Sports
Federation (USADSF) and are Deaf or hard of hearing
do not participate in the Paralympics, as they have
their own events in the Deaflympics. Although the
Special Olympics belongs to the U.S. Paralympics,
its members do not compete in U.S. Paralympic swim-
ming trials, nor do they compete at the international
Paralympics (see chapter 12).
• The USABA (www.usaba.org) has been a
crusader in swimming for people who are blind or
visually impaired and has included swimming in its
national competitions since 1980. It is a member
of the International Blind Sports Association (IBSA),
which was founded in 1981 (www.ibsa.es).
• DS/USA (www.dsusa.org), founded in 1967, is a
national organization dedicated to sport rehabilitation
for anyone with a permanent physical disability. In
particular, DS/USA is the national governing body of
sports for amputees. Its summer series of recreational
events includes water sports, and DS/USA sanctions
Introduction to Adapted Aquatics 
and conducts competitions and training camps as
part of its effort to prepare athletes for the Paralympic
Games.
• WSUSA (www.wsusa.org), dedicated to the
guidance and growth of wheelchair sports, was
founded in 1956. It is an umbrella organization that
coordinates the efforts of several associations, includ-
ing U.S. Wheelchair Swimming. It made its first foray
into international competition in 1957, and a U.S.
delegation was formed in 1959 and sent to England
to participate in the International Stokes Mandeville
Games. Athletes who typically swim with WSUSA
include, but are not limited to, people who use
wheelchairs due to spinal cord injury, spina bifida, or
amputation. Internationally, athletes who participate
under the banner of U.S. Wheelchair Swimming are
represented by WSUSA in the International Stoke
Mandeville Wheelchair Sports Federation and in the
Pan American Wheelchair Sports Federation, and
these athletes participate in the Paralympic Summer
Games every 4 years, if they qualify.
• The NDSA (www.ndsaonline.org) is an out-
growth of the United States Cerebral Palsy Athletic
Association, which has its roots in the National
Association of Sports for Cerebral Palsy, established in
1978. Originally just for athletes with cerebral palsy,
the organization has expanded to include survivors of
stroke, traumatic brain injury, and other related condi-
tions. Swimming has always been a tremendous part
of the NDSA’s competitive focus, and it was included
in the NDSA’s 1978 national games. Swimmers from
NDSA have been participating internationally with
the Cerebral Palsy International Sports and Recreation
Association (CPISRA) since 1982.
• DAAA (www.daaa.org) was founded in 1985
and held its first national sports competition in East
Lansing, Michigan, that same year. Swimming was
part of that competition and remains a vital part of
the National Dwarf Games. The World Dwarf Games
are conducted by the International Dwarf Athletic
Federation (IDAF) and were first held in 1993. They
now continue every 4 years
Competitive: Deaflympics
The USADSF provides for organized competition
among Deaf athletes. Since 1972, this organization
has sponsored swimming events in its national Deaf
sports festivals. The United States Aquatic Associa-
tion of the Deaf (USAAD), the U.S. national govern-
ing body of aquatics for Deaf athletes, is an affiliate
of USADSF and was formed in April of 1990. This
organization advocates, raises funds, and develops
training programs for elite swimmers and water polo
10 Adapted Aquatics Programming

players with a hearing loss of 55 decibels or greater in
the better ear. The USAAD also helps select athletes
to represent the United States in the Deaflympics,
the international Olympic counterpart for Deaf ath-
letes. The Deaflympics is conducted by the Comité
International des Sports des Sourds, the international
sports organization for Deaf athletes. Formally called
the International Silent Games (or International
Games for the Deaf) and World Games for the Deaf,
the Deaflympics has included swimming since its
inception in 1924. The U.S. team has participated
in the Deaflympics since 1957, when it competed
in Milan (J. Gunderson, personal correspondence,
June 7, 2004). Diving appeared in a few Deaflym-
pics but was abandoned due to a lack of entries (J.
Jordan, personal communication, June 6, 2004). The
United States has had a men’s water polo team in the
Deaflympics since 1981 (Reed Gershwind, personal
communication, June 14, 2004).
als with disabilities. Consequently, federally funded
organizations removed architectural barriers to
people with disabilities and the U.S. Architectural and
Transportation Barriers Compliance Board developed
accessibility codes. Many services became avail-
able for the first time to people with disabilities. For
example, federally funded organizations made park-
ing spaces, bathrooms, university classrooms, govern-
ment 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 (figure 1.4).

Legislation for Individuals With

Disabilities
Federal legislation has mandated the demise of
architectural barriers and has served as a catalyst
for encouraging school and agency programming
to accommodate all members of the community. In
addition, legislation has created funding opportuni-
ties to subsidize local and state fiscal concerns for
renovating existing structures and constructing new
facilities. Individuals with disabilities not only are
more visible but also are more vocal, as the laws have
empowered them to make their own decisions and
achieve greater independence. The motto “nothing
about us, without us” has resulted in individuals with
disabilities demanding more stringent laws and land-
mark access decisions. As accommodating people
with disabilities is a rapidly developing area of the Figure 1.4  Lifts provide individuals with physical disabili-
law, programs should seek professional advice as to ties access to swimming programs.
current regulations and allowable exceptions.

Architectural Barriers Act of 1968 Individuals With Disabilities

and Rehabilitation Act of 1973
In 1968, the U.S. Congress passed the Architectural
Barriers Act (ABA), which required U.S. buildings
and facilities to be accessible if they were designed,
built, or altered with certain federal funds or if they
were leased for occupancy by federal agencies (www.
access-board.gov/ada-aba/index.htm). In 1973, sec-
tion 504 of the Rehabilitation Act was enacted. It
mandated that all programs and facilities receiving
federal support must be made accessible to individu-
Education Act
The Individuals with Disabilities Education Act (IDEA)
began as the Education for All Handicapped Chil-
dren Act in 1975. This federal legislation continued
the thrust of the ABA and the Rehabilitation Act in
integrating individuals with disabilities into society.
It mandated free and appropriate public education,
including special education, in the least-restrictive
environment. As stated in the U.S. Federal Register,
a government publication that contains regulations

pertaining to laws, special education is defined as
instruction that is specially designed to meet the
unique needs of children with disabilities. This
instruction includes physical education. Physical
education is defined as
(I) 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). (Federal Register, 1977a)
Including aquatics in the definition of physical edu-
cation provides schools with the option of including
swimming in the curriculum for students with dis-
abilities (figure 1.5) and gives families the right to
access school swimming programs in which children
without disabilities are granted instruction.
Another important aspect of this law is the Indi-
vidualized Education Program (IEP), which helps to
make a child’s education appropriate. This document,
assembled by educators, related service professionals,
and parents, plots the goals a student is expected to
accomplish within the educational environment as
well as the steps necessary to achieve these goals.
Small group instruction, one-on-one assistants, and
modifications to the general curriculum may be
spelled out in the IEP. If aquatics is not specifically
mentioned on the IEP, it is not a required school
service.
It would be remiss to mention Public Law (PL)
94-142, the Education for All Handicapped Children
Act, without discussing some of its important amend-
Figure 1.5  Small-group instruction and instructional assistants are modifications made to
the aquatics curriculum to make a program appropriate for people with disabilities.
Introduction to Adapted Aquatics 11
ments and reauthorizations: PL 99-457, PL 101-476,
PL 105-17, and PL 108-446 (Individuals with Dis-
abilities Education Inprovement Act, or IDEIA). PL
99-457, the Education for All Handicapped Children
Act (reauthorization of 1980), expanded the age range
covered by the law from 3 to 21 to include infants and
toddlers from birth to 3 years old. Accordingly, parents
of young children with disabilities and personnel of
early intervention programs may seek community
aquatics programs as appropriate motor activities
for young children. By becoming familiar with these
laws, you can better meet the special needs of infants
and toddlers with disabilities.
You should also be familiar with the Individual-
ized Family Service Plan (IFSP), which was a result
of PL 99-457. The IFSP contains individual goals,
objectives, and methods for infants and toddlers with
disabilities and their family and service providers.
Some tips for working with children under 3 years
old are given on page 63.
PL 101-476, IDEA, was enacted in 1990 as an
amendment to the Education for All Handicapped
Children Act. PL 101-476 changed the term handi-
capped to individuals with disabilities, added autism
and traumatic brain injury as disability categories, and
stressed the importance of transitional services within
the IEP. Thus, the IEP must now include goals, objec-
tives, and a plan for the transition into the community.
This plan, called the Individualized Transition Plan,
projects what skills participants should have when they
leave the school. Transition refers to crossing the gaps
(a) between infant, toddler, and preschool programs
and school programs
and (b) between high
school programs and
lifetime pursuits. As an
aquatics instructor in a
school or community
facility, you might be
called on to contribute
to such a plan, espe-
cially for a young adult.
Seize these opportunities
whenever possible. After
all, what better lifetime
recreational pursuit is
there than aquatics?
PL 105-17 and PL
108-446 were the IDEA
amendments and reau-
thorizations of 1997
and 2004. PL 105-17
extended developmen-
tal delay to ages 3 to 9
12 Adapted Aquatics Programming
years (you can now place preschool and elementary
school children within this disability category rather
than just infants and toddlers). PL 108-446 slightly
modified the benchmark and objectives section of
the IEP and emphasized that highly qualified profes-
sionals provide service to students with disabilities.
It also added Tourette’s syndrome to the list of other
health impairments for students who are considered
to have a disability.
The laws thus far described in this section focused
on school or federally funded programs and build-
ings. The Americans with Disabilities Act, described
in the next section, has implications for all school
and community, public, and private facilities that are
open to the public.
Americans With Disabilities Act
The Americans with Disabilities Act (ADA), PL 101-
336, was passed in 1990 and mandated the elimina-
tion of discrimination against 54 million American
citizens with disabilities. Its standards are enforced
by the federal government (Center for an Accessible
Society, 2004). The ADA has widespread implications
for almost every area of life in the United States,
including recreation and aquatics. The law makes
illegal all discrimination based on disability and
provides for access to the goods and services of the
United States. It covers employment, public services,
transportation, public accommodations, services of
private entities, telecommunications, and activities of
state and local governments (www.usdoj.gov/crt/ada/
pubs/ada.txt). The section of the ADA dealing with
public accommodations (Title III) has the greatest
effect on aquatics participation by individuals with
disabilities. The specific terminology and intent of
Title III clearly apply to the aquatic realm. In the
following sections, we’ll look closely at the specific
terminology of this all-encompassing law and then
summarize its minimum requirements.
Qualified Individual
The U.S. Congress adopted the definition of dis-
ability first used in the Rehabilitation Act of 1973
(Federal Register, 1991). The law defines a qualified
individual as a person with a physical or mental
impairment that substantially limits one or more
of life’s major activities (www.ada.gov). Major life
activities include self-care, manual tasks, walking,
seeing, hearing, speaking, breathing, learning, and
working. Individuals with mobility or sensory impair-
ments, mental retardation, and other mental and
physical impairments as well as those with hidden
disabilities such as diabetes, cancer, epilepsy, heart
disease, mental illness, and HIV are all covered by
this law. In addition, the law includes people who
have a previous record of having an impairment (e.g.,
cancer in remission) and people perceived by others
as disabled, such as those who are HIV positive but
asymptomatic (Scott, 1990).
In Title III, a qualified person is one who meets the
ADA definition of being a person with a disability
and who has the prerequisite skills for participation
in a given physical activity (Dummer, 2003a). An
individual assessment of skills is the gold standard for
determining who is a qualified person under Title III.
Some experts use an informed consent document to
advise participants of the risks of a physical activity
if an individual assessment is impossible (Dummer,
2003a).
Reasonable Accommodation
Although reasonable accommodation is not firmly
defined in the ADA, experts consider it to be an action
that provides access to individuals with disabilities
by modifying previous policies, procedures, and
practices. The law specifically addresses discrimi-
nation in public accommodations and in services
operated by private entities. An organization cannot
exclude a person from participating in services, pro-
grams, or activities solely because of her disability.
If the person is otherwise qualified for a reasonable
accommodation, then an organization, school,
place of business, or community agency must allow
the individual access to the programs and facilities
(Sullivan, Lantz, & Zirkel, 2000). The U.S. Supreme
Court has interpreted reasonable accommodations
as those that do not require organizations “to lower
or to effect substantial modifications of standards to
accommodate” students with disabilities (Southeast-
ern Community College v. Davis, 1979, p. 413) and
that do not “impose undue financial and administra-
tive burdens or require a fundamental alteration in
the nature of the program” (School Board of Nassau
County v. Arline, 1987).
There are certain exceptions to having to provide
reasonable accommodations that must be judged
one case at a time. Some exceptions include the
following:
• When an individual does not meet the criteria
of a qualified person with a disability
• When an individual does not meet the qualifica-
tions to participate in the activity (i.e., a time
cut in the swim trials)
• When an individual’s participation creates
reasonable probability of substantial risk to
himself or others

• When program modifications significantly alter
the primary purpose of the set aquatics pro-
gram (e.g., a competitive diving meet may not
be able to reasonably accommodate a person
with atlantoaxial instability, for whom diving is
contraindicated)
Must-read materials on this subject include the article
“Reasonable Accommodations for Swimmers with
Disabilities” by Gail Dummer in Palaestra (Dummer,
2003a, pp. 44-45) and the article “Leveling the Play-
ing Field or Leveling the Players? Section 504, the
Americans with Disabilities Act, and Interscholastic
Sports” in the Journal of Special Education (Sullivan
et al., 2000).
The way to make modifications and reasonable
accommodations depends on many variables, such
as the specific disability issues for each person, the
programs and facilities that the person wants to
access, the amount of time given to make the accom-
modation, the dollar amount of the accommodation,
and the amount of support in the program and facility
administration. These variables may affect the method
that a pool operator uses to make a change for a given
participant, but the pool operator must make accom-
modations no matter what the variables.
The spirit of the ADA suggests that we should do
what we can to allow people with disabilities to
participate as much as possible in a given program
while ensuring the safety of all participants and
maintaining the intent of the program. The safety of
all participants is an important concept in the aquatic
realm. While some program accommodations might
seem reasonable to a participant with a disability, a
safety rule might prevent these accommodations. You
need to judge whether the rule is for the actual safety
of participants and cannot be modified or whether it
is in place for crowd control. For example, a person
who uses a prosthetic limb might want to remove her
prosthesis in the locker room and then hop to the pool
edge, but doing so would be a safety hazard because
of wet pool decks. Making an accommodation such as
providing a sitting bench close to the steps or poolside
would allow this person to use her prosthesis while
approaching the pool edge and it would also give her
a place to keep it dry while she is swimming.
Sometimes the aquatics staff may be unsure of what
to do about a request for an accommodation or may
believe that the accommodation is unreasonable. The
staff may feel that the participant is not appropriate
for the program or class for which the accommoda-
tion is being requested due to a lack of prerequisites
or that the request is outside of the realm of the class
or program. An example of this is a person who has
Down syndrome with atlantoaxial instability who
Introduction to Adapted Aquatics 13
wishes to dive but because of the instability in the
cervical area of his neck is not allowed to dive. His
family applied to a diving camp and asked for rea-
sonable accommodations for the child. They stated
that the child could learn the basics of the approach,
hurdle, and streamlined entry with a jump. While
the spirit of the ADA suggests that using a jump as a
modification to a dive might be possible, an accom-
modation does not need to be made if it subverts the
fundamental nature of the activity. Diving is diving,
not jumping. In good faith, the child could be served
if he understands that he is not allowed to dive, but as
a person with cognitive involvement who may make
a poor decision and try to dive from the board, it is
not in his best interest to be at this camp.
Courts consider it discrimination to place a person
in a segregated aquatics program based on her dis-
ability rather than on her ability. This means that a
facility cannot offer a person with a disability only the
segregated, adapted program. The segregated program
may be the one that is chosen by the participant,
caregivers, and aquatics instructor, but stereotyping
an individual and forcing her to accept an adapted
program is not permissible. One of the purposes of the
ADA is to integrate individuals with disabilities into
the mainstream of society. Therefore, the staff of each
facility needs to assess program admission policies,
looking for possible barriers to participation. Some
examples of reasonable accommodations in aquatics
programs include the following:
• Providing flotation devices for individuals who
cannot stand on the bottom of the pool while
they wait for instructions during swim lessons
(e.g., for people with paraplegia or dwarfism)
• Allowing a person who has a urine bag to wear
long, baggy shorts over the swimsuit to avoid
embarrassment
• Allowing an aide to participate, at no additional
cost, with an individual who needs support
• Providing a water chair and incorporating
arm movements into water aerobic classes for
people with lower-body impairments
• Designating an area on deck for guide dogs,
crutches, wheelchairs, and other mobility
equipment
• Installing nonskid carpet from the shower area
to the pool ladder for individuals who need
such help for balance, crutch traction, orienta-
tion, or mobility
• Providing auxiliary aids and services, such as
alternative formats (e.g., braille, computer disk),
for registrations, handouts, and certificates
14 Adapted Aquatics Programming
• Providing family and caregiver restrooms and
changing areas for caregivers of the opposite
gender so that they are able to provide assis-
tance
• Removing requirements that discriminate, such
as a height requirement of being able to stand
on the bottom of the pool, which individuals
who use wheelchairs or have dwarfism may not
be able to meet
It is not acceptable to claim the inconvenience or
inaccessibility of a facility as an inhibitor to participa-
tion. You cannot claim that a program is unavailable
because the staff is untrained. Further, your program
must avoid barriers of omission, or overlooking the
special needs of certain individuals. An example of
omission is circulating a program flyer that does not
include accessibility information and therefore will
not attract individuals with disabilities. The ADA
supports that a program should have an attitude of
accessibility and should seek knowledge of how to
serve individuals with disabilities.
Undue Hardship
An undue hardship defines situations in which
trying to accommodate an individual or to provide
general access would lead to profound costs or dif-
ficulty for an organization in respect to its size and
financial resources. A small nonprofit organization,
for example, might have such a narrow pool deck
that it cannot fit a transfer lift into the area to make
it accessible. To make the necessary accommoda-
tions, this organization would need to build a new
addition, knocking down the wall to extend the deck.
The organization may, in this case, plead undue hard-
ship, although “federal tax credits and deductions are
available to private entities for architectural barrier
removal in existing facilities. Federal funds are also
available through the Community Development Block
Grant Program to remove barriers in existing facili-
ties. Entities requesting guidance on their obligations
for existing facilities should contact the Department
of Justice” (www.access-board.gov). Organizations
that believe that their financial situation would be
overwhelmed by the cost of complying with the law
can apply for an exception to the law and show how
the modifications pose an undue financial burden.
In many cases, however, organizations can make
reasonable accommodations.
Readily Accessible
The ADA law uses the phrase readily accessible to
describe a facility that is easily and immediately
usable—in other words, a facility in which a person
with a disability can move around and use well (Scott,
1990). A readily accessible aquatics facility is one that
already has ample parking for people with disabilities,
an easily identifiable route into the facility, pools with
handrails and ramps, braille signs, family restrooms,
and usable lifts or movable pool floors.
Readily Achievable
Readily achievable refers to the ease with which a
facility can remove a barrier. If the barrier can be
removed easily, it is considered readily achievable.
Examples of readily achievable modifications that an
aquatics facility can make include removing bolted-
down benches and lowering hooks in locker rooms,
purchasing a Transfer Tier for getting into the pool,
printing aquatics manuals in braille, removing con-
crete door risers between shower and locker areas,
and removing footbath or water-collection troughs
on decks or in showers.
Minimum Requirements
The ADA has changed the face of architecture in
the United States and has allowed persons with dis-
abilities to access previously inaccessible areas and
programs. So why are there still questions about what
the ADA does and does not mandate after years of
its existence? It is because every facility has its own
unique issues. The ADA standards of 2004 eliminated
some of the uncertainty that surrounded what is and
what is not accessible in relation to pools. These new
amendments to the original guidelines include specif-
ics for swimming pools, wading pools, and spas.
The ADA Accessibility Guidelines (ADAAG) set
the standard that is applied to buildings and facili-
ties. They address only the built environment (struc-
tures and grounds). Reasonable accommodation in
operational issues, procedures, and policies is not
addressed in the ADAAG, but is a more nebulous
area that relies on the spirit of the law and is not
written in black and white. Best practice emerges
from possible court decisions and standard of care
in relation to health and safety practices. Program
issues revolve around what is reasonable in reason-
able accommodations, which is what the law intends
for public accommodations in your aquatics facility.
While the law attempts to level the playing field for
persons with disabilities, providing them with equal
accessibility to (in our case) aquatics programs, what
is reasonable may differ from pool to pool, depending
on the program. However, the ADA asks us to adapt
our policies, facilities, and programs so that people
with disabilities can participate with people without
disabilities in mainstream American life.
To meet all pertinent legislation, where should
you start? The first item on your list of things to do

is to obtain a copy of Accessible Swimming Pools
and Spas: A Summary of Accessibility Guidelines
for Recreation Facilities, a manual published by the
United States Access Board (2003). You may either
download it (www.access-board.gov) or send for it by
mail (1331 F Street NW, Suite 1000, Washington, DC
20004-1111). This manual will guide you through the
specific guidelines that were published in the Federal
Register at 67 FR 56352 on September 3, 2002, and
summarizes the applicable issues published later in
the July 23, 2004, Federal Register. The accessibility
guidelines are for newly constructed and altered
recreation facilities, including swimming pools,
wading pools, and spas. The manual also includes
information on wave-action pools, leisure rivers, and
sand-bottom pools. For a summary of these minimum
requirements, see the sidebar Accessibility Guidelines
for Swimming Pools on this page.
Accessibility Guidelines
for Swimming Pools
❚ Swimming pools with less than 300
linear feet (91.4 meters) of pool wall:
The primary means of entry must be
either a sloped entry into the water or a
pool lift that is capable of being oper-
ated independently by a person with a
disability.
❚ Swimming pools with over 300 linear
feet (91.4 meters) of pool wall: A mini-
mum of two means of accessibility are
required; the primary means must be
either a sloped entry into the water or an
independently operated pool lift, while
the secondary means can be a lift, sloped
entry, transfer wall, transfer system, or pool
stairs. It is recommended that the second-
ary means does not duplicate the primary
means.
❚ Aquatic recreation facilities including
a wave-action pool or leisure river:
At least one accessible means of entry,
such as a pool lift, sloped entry, or trans-
fer system, must be provided.
❚ Wading pools: One sloped entry into
the deepest part of the pool is required,
but handrails are not required.
❚ Spas: At least one accessible means of
entry, which can be a pool lift, transfer
wall, or transfer system, is required.
From Accessible Swimming Pools and Spas Access Board, 2003.
Introduction to Adapted Aquatics 15
You may be wondering how much a pool has to be
altered in order for the work to be deemed an altera-
tion by the ADA. Alterations are changes that affect
the usability of a pool and are not just “safe main-
tenance” type of work (Peggy Greenwell, personal
communication, April 26, 2004). The Access Board
addresses the issue of accessibility for existing rec-
reation facilities on its Web site (www.access-board.
gov/recreation/final.htm) and in the Federal Register
dated September 3, 2002. In summary, Title II of the
ADA obliges state and local governments providing
recreation facilities and Title III obliges private entities
providing recreation facilities to remove architec-
tural barriers in existing facilities where it is readily
achievable. Existing pools have an obligation to the
U.S. Justice Department to remove barriers over time
to provide access. For more information on specific
accessibility means, see chapter 6.
Benefits of Aquatics
Participation
Aquatics participation can foster physical, social,
emotional, cognitive, and leisure skill development.
Participants in adapted aquatics learn valuable motor
skills—but so much more can come from good plan-
ning, adept instructors, transdisciplinary sharing, and
appropriate student-to-teacher ratios.
Appeal of Water
The recreational, educational, and therapeutic value
of water has long been recognized. With an estimated
103 million people swimming each year for survival,
recreation, or competition (ARC, 2004a), and with
pools and other aquatics facilities readily available
in the United States, aquatic activities are available
to many and are usually inexpensive.
Aquatic activities provide a form of exercise that
is perceived as relaxing and socially acceptable.
Swimming has many social and emotional benefits
that can be carried over to other functional activities,
and quality adapted aquatics can create lifelong skills,
independence, and feelings of accomplishment.
Although water activities do not magically solve
life’s problems, swimming enriches life and provides
opportunities for increased morale and body image
(Benedict & Freeman, 1993), improved mood (Berger
& Owen, 1992), and decreased depression (Stein &
Motta, 1992). For individuals with disabilities, an
empty wheelchair or a pair of crutches left on the
pool deck means freedom of movement and a feel-
ing of success, which enhance self-image. In short,
16 Adapted Aquatics Programming
swimming is a fun activity that has many physical,
social, emotional, cognitive, and recreational benefits
that make it appealing to participants, therapists, and
instructors alike.
Physical Benefits
The physical benefits of aquatics are well docu-
mented, as aquatic immersion is an ideal environment
to mimic weightlessness. NASA and other groups of
scientists use aquatics to measure the physiological
responses of the body in their effort to understand the
effects of space travel and living on the human body
(Becker, 2004). The physiological benefits come from
two distinct sources: the biological effects of water
itself and the physical and therapeutic benefits of
participation in aquatic activities. Although adapted
aquatics does not focus on therapeutic water exercise,
warm water itself facilitates therapeutic goals and is
useful for healing some diseases and ailments. The
application of water, usually through immersion, is
called medical hydrology (Becker, 2004). Biological
effects of immersion in warm (92-96 °F, or 33.3-
35.6 °C) water include the effective transfer of heat
to the body, which in essence relieves pain and
promotes relaxation due to thermal energy transfer;
the weightlessness effects produced by the interac-
tion between buoyancy and hydrostatic pressure;
and the viscosity and cohesion properties of water,
which support the body and at the same time provide
resistance (Vargas, 2004). Other biological benefits
of immersing the body up to the chest (or higher)
include lymphatic compression, venous compression,
increased central blood volume, increased cardiac
volume, increased atrial pressure, increased stroke
volume, increased cardiac output, increased work
of breathing, increased oxygen delivery, improved
dependent edema, increased muscle blood flow, off-
loading of body weight, decreased joint compression
with movement, increased blood flow to kidneys,
higher pain threshold, suppression of sympathetic
nervous system activity, and promotion of excretion
of metabolic waste (Becker, 2004).
Movement in water, including movement through
adapted aquatic activities, can therefore yield the
following physical benefits: relaxation, relief of pain
and muscle spasms, maintained or increased range of
motion in joints, reeducation of paralyzed muscles,
and improved muscle strength and endurance (Skin-
ner & Thompson, 1983). The aquatic environment
helps establish early patterns of movement that may
constitute the first time a person is able to explore
movement possibilities. Specifically, swimming
strengthens muscles that enhance posture, thereby
helping to develop the stability needed to learn skills
for locomotion and object control (Horvat, Forbus,
& Van Kirk, 1987).
Lack of physical movement and aerobic exercise
often causes individuals with disabilities to have
decreased vital capacity of the lungs. Vital capacity is
the amount of air a person can exhale after the deep-
est possible inhalation. Adapted aquatic activities can
help improve breath control and cardiorespiratory
fitness. Blowing bubbles, holding the breath, and
breathing out through the mouth and nose all improve
respiratory function as well as oral motor control,
which can aid speech and decrease drooling and
feeding problems (Martin, 1983). In addition, water
immersion exerts pressure on the respiratory system
and increases breathing work by approximately 60%,
which in combination with the rhythmic breathing
and other breath control activities so prominent in
aquatics programs strengthens respiratory muscles
and enhances respiration. The water supports the
body and counteracts gravity so that a person who
cannot walk on land may be able to walk in water,
thereby strengthening the muscles needed for walking
on land. Using adapted aquatics to increase fitness
may be more beneficial for people with disabilities,
as movement is easier in a water-based program than
in a land-based program.
Water also stimulates the sites where the body
takes in information (water acts as a perceptual
stimulant), such as the skin, the vestibular system (the
system that facilitates balance), and the visual and
auditory systems (Campion, 1997). The skin reacts
to different temperatures and sensations (provided
through water, towels, and pool floor and walls), the
vestibular system to the turbulence of the water, the
eyes to the ever-changing water surface, and the ears
to the increased pressure that they encounter when
submerged. Thus, for individuals with disabilities
who require sensory stimulation, water can be an
important part of therapy. By sharing their goals for
the client, physical and occupational therapists can
help the aquatics instructor provide activities that are
therapeutic as well as instructional, possibly leading
to increased benefits for the participant. In fact, the
more that participants practice the same skills in a
variety of environments, the more that they generalize
the skills to other situations.
Finally, a person with a disability may use the
aquatic fitness and swim skills gained in your class
to participate in enrichment aquatic activities such as
boating, waterskiing, and scuba diving (see chapter
12). The physical benefits of increased fitness and
functional skills can carry over into other physical
activities and recreational opportunities. Aquatic

activity can be a fun way to improve vital lung
capacity, flexibility, muscle tone, and overall fitness
without putting undue pressure on joints (“Aquatic
Sports,” 1993).
Social and Emotional Benefits
A quality aquatics program can facilitate social and
emotional benefits in addition to physical wellness
(Benedict & Freeman, 1993; Berger & Owen, 1992;
Stein & Motta, 1992). Warm water has a sedative
effect and produces physical and mental relaxation.
The ability to move more easily in water fosters
a level of independence and control that some
people with physical disabilities cannot achieve
on land. Enjoyment of swimming is a social asset
(Campion, 1997) that can carry over to other areas
of life. A person with a physical disability who sees
himself as a more independent mover in the water
can improve his body image, which is a powerful
motivator for an improved self-image. “For young
people, whose sense of self may be a direct result of
body image and athletic proficiency, residual motor
impairment can be a particularly negative variable”
(Telzrow, 1987, p. 538). The freedom of movement
made possible by water not only boosts morale but
also gives individuals with disabilities the incentive
to maximize their potentials in other aspects of reha-
bilitation (Skinner & Thompson, 1983). Social benefits
are fostered in an aquatics program that is carefully
planned and implemented by a qualified instructor.
A better knowledge and appreciation of aquatic
activities, which include educational, recreational,
and competitive possibilities, increases the variety
of activities that people with disabilities can engage
in. The opportunity to participate in fun activities
can lead to increased awareness of age-appropriate,
community experiences. A sense of well-being and
freedom temporarily releases an individual from ten-
sion and stress, which in many cases may compound
the effects of physical disabilities.
The social and emotional benefits of newfound
recreational experiences have a lasting positive
effect on people with disabilities or on anyone else.
Aquatic recreation facilitates a worthy yet enjoyable
use of leisure time as well as helps participants meet
their cognitive, physical, social, and emotional goals.
Statistics show that many individuals with disabilities
have more than the average amount of leisure time
(West, 1991). Using leisure time wisely often makes
the difference between a person who is socially iso-
lated and has poor self-esteem and one who is stimu-
lated through socialization with others to achieve
self-actualization (Austin & Crawford, 1991).
Introduction to Adapted Aquatics 17
Cognitive and Intellectual Benefits
The motivational and therapeutic properties of water
provide a stimulating learning environment, even
for individuals with more severe disabilities (Dulcy,
1983a). Movement exploration helps participants
understand their own bodies and how they move.
It can particularly benefit persons with traumatic
injuries who may lack knowledge about how their
bodies now move. Some instructors have integrated
academic learning with adapted aquatics, success-
fully reinforcing cognitive concepts (ARC, 1977). For
example, these creative instructors have centered
water games on math, spelling, reading, and other
such skills. Participants may count laps, dive for
submerged plastic letters, or read their workouts.
These activities also help participants improve their
judgment and orientation to surroundings.
About 6 million school-aged children are served
by IDEA, and over 3 million of these children have
learning, cognitive, or intellectual disabilities (U.S.
Department of Education, 2002). A trained instructor
can properly present activities that focus on problem
solving, counting, speaking in full sentences, memo-
rizing, and working from left to right in order to rein-
force reading—all in the aquatic environment.
Applications of Aquatics
Participation
Adapted aquatics, adapted water exercise, therapeutic
water exercise, aquatic therapy, and adapted swim-
ming are terms that have been associated with aquat-
ics participation by individuals with disabilities. This
section defines and compares these various applica-
tions of aquatics participation. The term adapted
aquatics has been used to mean many different things.
Before aquatic activities were separated into uses for
education and recreation and uses for therapy, some
professionals used adapted aquatics to denote all
water activities for people with disabilities, without
regard for purpose or outcome. Some professionals
believe that the term adapted aquatics has run its
course, has negative connotations, and connotes out-
dated concepts that focus on therapeutic applications
rather than typical aquatic activities (Stein, 2002). At
one time “adapted aquatics was what anyone was
doing in water with any individual with a disability”
(Grosse, 1996, p. 20). As seen in this book and in the
1996 AAALF Aquatic Council position paper, the term
denotes aquatics programs involving individuals with
disabilities and (1) the necessary modifications for
18 Adapted Aquatics Programming
instructional strategies, facilities, and equipment; (2)
modifications and support of mobility from one area
to another; and (3) changes to communication and
movements for swim strokes, water safety, and other
aquatic activities. In this arena, adapted aquatics is
used to improve fitness, swim strokes, water safety,
and quality of leisure time through instructional tasks,
corrective feedback, and structured practice. There
are other phrases that are used and confused with
adapted aquatics programs, such as adapted water
exercise, therapeutic water exercise, and aquatic
therapy.
Adapted water exercise programs transfer active
exercises that are typically done on land to the
medium of water. Aquatics professionals with cer-
tifications in water fitness or aquatic therapy adapt
land exercises to the needs of individuals with acute
or chronic disabilities. The goals of these programs
are similar to those of hydrotherapy, but adapted
water exercise programs do not use whirlpools,
contrast baths, or passive exercises as hydrotherapy
does. Professionals who use these programs include
aquatics instructors who are trained specifically for
the Arthritis Foundation/YMCA Aquatics Program
and the National Multiple Sclerosis Society, kinesio-
Figure 1.6  Adapted aquatics is not adapted water exercise, but the two can complement each other.
therapists, physical educators, therapeutic recreation
specialists, athletic trainers and specialists in sports
medicine, and physical and occupational therapists
(see figure 1.6).
Therapeutic water exercises are aquatic move-
ments that are specially prescribed for a particular
individual. Therapeutic water exercise protocols
should be authorized by a physician and conducted
by a physical therapist, athletic trainer, or kinesio-
therapist who has aquatics training. Aquatics pro-
grams using the medical model, such as hydrotherapy
and adapted and therapeutic water exercise, may
be categorized under the broad category of aquatic
therapy (see also chapter 2). Aquatic therapy is “the
process of working with patients to actively or pas-
sively rehabilitate musculoskeletal, neurological,
and/or cardiopulmonary conditions using water and
a pool as the primary therapeutic medium” (Vargas,
2004, p. 1).
An adapted swimming program modifies swim
strokes for individuals who do not have the strength,
flexibility, or endurance to perform the standard
version (see figure 1.7). Adapted swimming is part
of adapted aquatics. Adapted aquatics is the more
comprehensive label for programs that use swim-

Photo courtesy of Monica Lepore
Figure 1.7  Adapting swim strokes and skills takes creativity and experimentation.
ming, water safety, and aquatic recreational activities
to promote health and rehabilitation. While adapted
aquatics encompasses more than swim strokes, it does
not include therapeutic water exercise, hydrotherapy,
or aquatic therapy. Some professionals in the field
would rather refer to adapted aquatics as adapted
swimming when discussing the nonmedical aspects
of this field. Their concern is that potential partici-
pants and medical personnel might misunderstand
the implications of adapted aquatics, thinking that a
program labeled as adapted aquatics includes thera-
peutic water exercise. These professionals believe
that the term adapted aquatics reflects the entire
scope of adapted water activities, including swim-
ming, exercise, rehabilitation, safety, and recreation.
In this book, however, adapted aquatics reflects the
philosophy of adapting swimming, safety, and aquatic
recreational activities to the needs of individuals
with unique needs. Adapted aquatics is a method,
program, and process that parallels adapted physical
education, its equal on land.
As a method, adapted aquatics parallels adapted
physical education in that it strives to modify any exist-
ing swim stroke, game, or activity to meet the needs of
individuals with special needs (Sherrill, 2004). As the
instructor, you can make these modifications within an
integrated or segregated swim program. Acceptance of
all people and an open, creative mind are beneficial
instructor attributes. Sherrill (2004) implies that all
good teachers adapt the curriculum so that a student
has minimal failures and the preservation of ego
strength. Whether or not you intend to specialize in
adapted aquatics, you should familiarize yourself with
Introduction to Adapted Aquatics 19
methods for adapting aquatic
activities so that you can inte-
grate individuals who may
benefit from general aquatic
activities into your programs.
Specialized study and practi-
cal experience with instructors
who practice adapted aquat-
ics can help you as a general
swim instructor become more
proficient in this field. Indeed,
the methods of adapted aquat-
ics may apply to any person
who needs adaptations in
order to learn swimming and
water safety.
As a program, adapted
aquatics can be a segregated
placement for those individu-
als with unique needs that you
cannot accommodate within
any other program. Individu-
als or their caregivers may opt for a separate program
of aquatic games, activities, swim strokes, and rec-
reation to meet their own comfort levels and needs.
But remember, federal law mandates that segregated
programs not be the sole programs that you offer to
individuals with disabilities.
As a process, adapted aquatics focuses on deliver-
ing a full range of aquatics programs to individuals
with disabilities. This process includes identification,
assessment, placement, teaching, and evaluation
to ensure that placement is appropriate. We have
adapted our view of adapted aquatics as a service
delivery system (process) in aquatics from Claudine
Sherrill’s position on adapted physical education
(2004). For more information on this, see chapter 3.
Summary
Although aquatics programs have long provided
therapeutic benefits, adapted aquatics promotes the
modification of instructional and recreational swim-
ming activities and encompasses changes to swim
strokes, water safety training, and recreational aquatic
activities that relate to swimming. Although the use of
aquatics for individuals with disabilities in the United
States grew out of therapy programs in the 1920s and
30s (and even those more ancient), you should not
confuse aquatic therapy, therapeutic water exercise,
or hydrotherapy with adapted aquatics.
Why adapted aquatics? As an aquatics profes-
sional, you should advocate for the hard-won changes
20 Adapted Aquatics Programming

in facility and program accessibility, particularly in
light of the proven benefits of aquatics for people
with disabilities. Indeed, the appeal of water leads
to social, emotional, cognitive, and physical gains.
Thus, throughout this book, we’ll focus on swimming,
water safety, and recreational aquatics for individuals
with disabilities who cannot successfully or safely
participate in general aquatics programs or who have
special needs in the inclusive setting. Whether you’re
learning about adapted aquatics for the first time or
you are a seasoned instructor, this book will give you
not only theory, but also practical, field-tested sug-
gestions for providing safe, successful, and relevant
aquatics programs as you strive to accommodate
individuals with disabilities, and do so while provid-
ing the dignity that all participants deserve.

Chapter 1
Review 1. What nationally recognized organizations accommodate individuals with
disabilities in their instructional swimming programs?
2. What are two organizations that provide instructor credentials to teachers
of swimming for individuals with disabilities?
3. How do hydrotherapy, adapted aquatics, and therapeutic water exercise
differ?
4. What two organizations team up to provide an aquatics program for
people with arthritis?
5. What are some organizations that provide nationally recognized water
exercise programs for people with disabilities?
6. Which law mandates that all federally funded programs are made acces-
sible for people with disabilities?
7. What is the current name of the law that provides for education, including
physical education, in the least-restrictive environment?
8. Which law has a definition of physical education that includes aquatics?
9. Which law mandates an IEP as part of special education?
10. What is an Individualized Transition Plan and how can it help with commu-
nity living and lifetime recreation including aquatics?
11. Which law mandates the elimination of discrimination or barriers against
people with disabilities in all private pools in the public eye?
12. Which law provides for reasonable accommodations for people with dis-
abilities in public pools and locker areas?
13. What are the physical benefits of immersion in warm water?
14. What are the psychological benefits of swimming for persons with disabili-
ties?
15. What are the primary means of pool access for people with disabilities
that must be included when constructing new pools?
16. What can be the secondary means of pool access for people with dis-
abilities that must be included when constructing new pools?
 2
Models of
Collaboration in
Adapted Aquatics
M r. Moore is the specialist in adapted aquatics for the Wright School District.
Until last spring he was an itinerant adapted physical education (APE)
teacher, visiting 12 schools across the county each week. Although he was consid-
ered a member of the school district’s multifactored team (M-team), his schedule
rarely allowed him to attend IEP meetings. He provided his assessment data and
recommendations via other team members. After a self-evaluation, the school dis-
trict placed a greater emphasis on transition services for students aged 14 and older,
and thus Mr. Moore’s position was redefined. He started to attend IEP meetings and
through collaboration with caregivers, students with disabilities, and school district
personnel helped select aquatics as an area of emphasis for all eligible students
in order to address concerns in transition services. While adapted aquatics was a
primary area of emphasis, Mr. Moore and other APE personnel provided coordi-
nated land-based adapted physical education and also emphasized lifelong leisure
skill development. Everyone understands that collaboration is an integral part of
schools, and Mr. Moore now attends regularly scheduled meetings with the district’s
M-team. His attendance has resulted in educating M-team collaborators about the
contribution of adapted aquatics as a lifelong activity for people with disabilities.
When individual collaborators attend and participate in team meetings, both team
members and students benefit from direct professional input. In this example, all
team members learned about the importance of adapted aquatics as a lifelong
leisure activity to include as a transitional component for eligible students.

21
22 Adapted Aquatics Programming
T he number of individuals using aquatics for physi-
cal improvement has grown tremendously for
many reasons. One reason is the continued prolifera-
tion of organizations such as the AEA, ATRI, USWFA,
American Physical Therapy Aquatic Therapy Section,
and aquatic network of the American Occupational
Therapy Association. Each contributes to opportuni-
ties for professional development through in-service
and preservice training for professionals who provide
diverse programming for individuals with temporary
or permanent disabilities. As a result of the influence
of these organizations, allied health care profession-
als have joined aquatics instructors in using aquatics
facilities, focusing on delivering aquatics programs
centered on activities or exercises other than swim-
ming and water safety. Federal legislative statutes
requiring facilities and programs to be accessible
to individuals with disabilities have also increased
participation. In addition, senior citizens with and
without disabilities have contributed to a resurgence
of interest in water exercise. Aquatic therapeutic
exercise (aquatic therapy) provides exercise program-
ming that conditions cardiovascular fitness, flexibility,
strength, and muscle endurance. Such programming
can be instituted early in a rehabilitation program
and continued independently of land-based exercise
(Houglum, 2001).
In this chapter, we’ll profile four models used in
developing programs to serve the basic needs of
individuals with disabilities: the medical-therapeutic
model, the educational model, the recreation model,
and the transdisciplinary model. In addition, we’ll
examine the distinct components, goals, and objec-
tives of these models as well as the professional
roles necessary to apply each model in the aquatic
realm.
Chapter Objectives
From this chapter, you will learn the
following:
* The medical-therapeutic model, the
educational model, the recreation
model, and the transdisciplinary model
can be used in providing adapted
aquatics programs, and each requires
distinct professional roles in its applica-
tion.
* Philosophy is the foundation of all aquat-
ics programs.
* There are community recreation options,
such as YMCA pools, water parks, or city
or county pools, that can be used when
providing aquatics programs for indi-
viduals with disabilities.
* Individual and team collaboration have
different characteristics. Individual col-
laboration includes viewing others as
equally competent and understand-
ing that people communicate in vari-
ous ways. Team collaboration includes
respect for due process of parents and
caregivers, ethical leadership, and open
documentation.
Models for Adapted Aquatics
A model represents a discipline and substantiates its
components. The model defines the relationships and
demonstrates unity between the components. Models
represent a concept and should simplify understand-
ing the concept. They are not just a mathematical
equation or a model bicycle. Models for a profes-
sional practice discipline should provide a portrait
of the components of the discipline, define how they
interlock, and provide direction for the practitioner.
Medical-Therapeutic Model
Over the centuries, English, Greek, and Roman
physicians prescribed healing baths, a practice that
evolved into the therapeutic use of aquatics called
hydrotherapy. The meaning of hydrotherapy is derived
from two Greek words, hydro (water) and therapia
(healing). To apply the hydrotherapy modality, the
medical profession typically used various tests to
diagnose a problem, assigned the problem a medi-
cal term or disability category, and then prescribed
a specific course of treatment to remediate, cure, or
control the symptoms of the problem. Aquatics as a
medical prescription follows this model, known as the
medical-therapeutic model. In the United States, the
treatment of disease, disability, and ill health through
aquatics is called hydrotherapy, aquatic therapy, or
aqua therapy. Physicians prescribe it for the short- or
long-term treatment of burns, peripheral vascular dis-
orders, and all types of orthopedic and neurological
impairments and athletic injuries.
Distinct Components
The distinct components of the medical-therapeutic
model of aquatic service include physician prescrip-

tion or referral, problem-oriented reporting, disability-
specific treatment, and active and passive exercises
conducted by therapy specialists.
Physician Prescription or Referral
Typically, physicians who specialize in physical
medicine, orthopedics, rehabilitation, neurology, or
rheumatology are the most knowledgeable about the
benefits of aquatic activity and thus, in general, refer
the most patients to aquatic therapy. When physicians
refer a patient to aquatic therapy, they often prescribe
the number of sessions per week, the total number
of sessions that they believe will be beneficial, the
types of exercises to be used, and, most important,
the specific objectives the therapy should achieve.
Prescribed objectives may be as vague as “to increase
range of motion” or as specific as “to increase range
of motion in the knee to 130°.”
Problem-Oriented Reporting
Problem solving is a distinct component of the
medical-therapeutic model. Once the physician
prescribes the therapy, the patient seeks a therapist,
who works with the physician to draw up a prob-
lem-oriented report (POR). The POR focuses on the
patient’s problems, ways to solve those problems,
treatments the medical team will apply, and health
professionals responsible for solving each problem.
Meticulous record keeping is typical in the medical-
therapeutic model, with the therapist writing weekly
reports and monthly summaries of progress toward
and setbacks from goals and objectives. Third-party
insurance reimbursements that occur with programs
following the medical-therapeutic model generally
demand such attention to detail.
Disability-Specific Treatment
Another distinct component of the medical-therapeutic
model is the focus on the disability. Often, a diagnosis
of a given disability sets into motion a specific treat-
ment plan. This is known as a categorical approach,
in which the medical team builds exercises, activities,
and contraindications around typical characteristics of
a disability and uses these generic approaches with all
or most patients who have that disability. Disability-
specific treatment takes into account physical and
mental conditions, ensuring that important safety
information is available if the person is subject to sei-
zures, ataxic movements, impulsive acts, or abnormal
movements due to neurological dysfunction.
Specific Exercises
Professionals such as physical and occupational
therapists, kinesiotherapists, and athletic trainers (spe-
Models of Collaboration in Adapted Aquatics 23
cialists in sports medicine) usually develop a distinct
exercise protocol for each disability and then modify
these protocols to fit an individual’s specific physical
characteristics. Methods of treatment include posi-
tioning, using anatomical movements underwater,
and using progressions of developmental sequences.
The properties of water, including specific gravity
(relative density), buoyancy, temperature, hydrostatic
pressure, and viscosity, affect the way people exer-
cise, and therefore professionals need to be aware
of these effects (Houglum, 2001, p. 409; Schrepfer,
2002; Walsh, 1990).
Goals and Objectives
Goals are broad outcome statements that guide a pro-
gram or an individual within a program. Objectives
are specific statements that reflect a future observable
and measurable outcome for an individual within a
program. This section describes typical goals of pro-
grams that operate within the medical-therapeutic
model and gives examples of goals and objectives
for participants in those programs (also see chapter
10).
The main goals of any medical-therapeutic
aquatics program are the restoration, maintenance,
and development of functional capacities through
positions, exercises, and activities that reduce pain
and prevent deformity and further disability. Also
included is the improvement of circulation, motor
skills, muscular strength, muscular endurance, range
of motion, balance, and coordination so that patients
may function at their maximum potentials (Sherrill
& Dummer, 2004, p. 455). Specifically, medical-
therapeutic aquatics programs use hydrodynamic
principles and underwater exercise to enhance the
treatment program of an individual (Brody, 1999).
Goals and objectives for aquatic therapy programs
that operate under the medical-therapeutic model are
generally those prescribed for therapeutic exercise
on land. Aquatic activities are generally easier and
more enjoyable than land activities and so are quite
popular for achieving therapeutic goals.
Common goals under the medical-therapeutic
model include but are not limited to the following:
• To improve circulation
• To improve range of motion
• To improve independent ambulation
• To decrease abnormal muscle tone
• To facilitate weight-bearing tolerance in trans-
ferring activities
• To improve vital lung capacity
24 Adapted Aquatics Programming
Goals assimilated from the model delineate what
participants will perform within a specific program.
The treatment team translates these general program
goals into goals and objectives that fit the needs of
individual participants. The following are typical goals
and objectives for participants in programs guided by
the medical-therapeutic model:
Participant Goals
• To improve range of motion in extremities
• To maintain vital lung capacity
• To increase weight-bearing tolerance
Participant Objectives
• Participant will increase range of motion in
elbow by 20° by March as a result of elbow
flexion and extension exercises during aquatic
therapy sessions.
• Participant will maintain vital lung capacity of
23 liters of oxygen per minute by swimming the
front crawl for 200 meters 4 times per week.
• Participant will show increased weight-bearing
tolerance by standing on flat feet in 4 feet (1.2
meters) of water for 5-minute intervals 3 times
per 60-minute aquatic therapy session 3 times
per week.
Settings
The settings for aquatic services within the medical-
therapeutic model include community as well as hos-
pital-based facilities. Hospitals, rehabilitation centers,
or private practices may rent private and public pools
for 1 or more hours per week to facilitate community
outreach. Additional settings in which the medical-
therapeutic model of aquatics occurs include reha-
bilitation centers, nursing homes, intermediate- and
long-term care facilities, health and wellness facilities,
and sports medicine centers (also see chapter 10).
Providers
Aquatic therapy, operating within the medical-
therapeutic model, is reaching the masses through
aquatic therapists. A question often asked is, who are
aquatic therapists? They are specialists in aquatics,
movement, and chronic and acute disabilities and
diseases. They often have degrees in sports medicine
as certified athletic trainers (ATCs) or certified strength
and conditioning coaches (CSCSs), in kinesiotherapy,
in APE, in physical or occupational therapy, or in
therapeutic recreation (TR). However, the answer to
who is an aquatic therapist is still unresolved, and this
service continues to evolve. As associations such as
the American Physical Therapy Association, American
Occupational Therapy Association, National Athletic
Trainers’ Association, and AAPAR Council for Aquatic
Professionals within AAHPERD continue to expand
their aquatic therapy networks, aquatic therapy cer-
tification will continue to mature.
Aquatic therapy provided by physical therapists
has always functioned under the medical-therapeutic
model. Aquatic activities are delivered under a phy-
sician’s prescription and are supervised by a licensed
physical therapist. Some states do not require a
physician’s prescription and thus allow individuals
direct access to physical therapy. Physical therapy
assistants may provide one-on-one contact in the
pool and conduct some of the active therapy. In the
last decade, other allied health professionals have
used water as a therapeutic medium to meet treat-
ment goals. Sports medicine specialists, also known
as athletic trainers, provide aquatic therapy, using it to
rehabilitate athletic injuries. Athletic training and sports
medicine function under the medical-therapeutic
model much like physical therapy does.
Occupational therapists help individuals with dis-
abilities acquire, practice, and refine activities that
are necessary to function in daily life. Occupational
therapy is the “therapeutic use of self-care, work,
and play activities to increase independent function,
enhance development, and prevent disability” (Hop-
kins & Smith, 1993, p. 4). Occupational therapists
work in hospitals, rehabilitation centers, nursing
homes, and schools to introduce skills involving
dressing, transferring, self-maintenance, sensory
integration, vocational training, and leisure. In the
aquatic setting, occupational therapists work with
their clients to help sequence normalized movements,
provide proper positioning, and encourage self-care
(see figure 2.1). The water is the perfect setting to
develop sensory integration, as it requires constant
adjustment to changing depth, surface movement,
and pressure.
Kinesiotherapists use education and exercise in
both aquatic and nonaquatic settings to treat the
effects of disabilities, injuries, and diseases. In the
past, kinesiotherapists were known as corrective
therapists and worked mainly within the Veterans’
Administration hospitals, but they have recently
entered private practice to offer their services in a
variety of community health care facilities. Kinesio-
therapists work with physicians to “act as a bridge
between traditional physical therapy in hospitals or
clinics, work tolerance programs and return to work”
(Meyer, 1994, p. ii).
The certified TR specialist (CTRS) receives addi-
tional training in aquatics and helps individuals

Figure 2.1  The sequencing of manipulative skills is enhanced through therapeutic aquatics.
with disabilities reach their full physical, emotional,
cognitive, and social potential through recreational
aquatic activities. These specialists are employed in
both clinical and community settings.
Important Issues
Applying the medical-therapeutic model to the
aquatic setting has several shortcomings. Programs
operating within the medical-therapeutic model often
lose sight of the enjoyment and learning aspects of
aquatics. This narrow view can lessen benefits simply
by becoming monotonous.
Therapists who do not have training in aquatic
safety may be unaware of the potential contraindi-
cations of a disability in the aquatic setting or the
associated safety precautions. Without the knowledge
to assess, plan, implement, and evaluate aquatic
skills, inadequately trained therapists may overlook
safety hazards, compromising their ability to foresee,
prevent, and respond to aquatic emergencies. In addi-
tion, therapists who are comfortable walking in the
shallow end of a pool may pose a risk to themselves
and others if they lack swimming and water safety
skills needed in deeper water.
Experts often view the medical-therapeutic model
as categorical in that it groups individuals according
to common pathology. Hospitals commonly have
separate programs for different disabilities. To make
matters worse, such programs often use negative
terminology and sometimes focus on the individual’s
Models of Collaboration in Adapted Aquatics 25
Photo courtesy of Jean Skinner
disorder, diagnosis, or disability rather than on the
individual’s abilities. Thus, the medical-therapeutic
model may not allow an adequate view of the whole
person.
Educational Model
The educational model of adapted aquatics instruc-
tion resulted from several factors, including the
ARC and YMCA progressive swim models, the APE
service delivery model that came from IDEA, and
the social minority model of viewing individuals
with disabilities. The educational model differs from
the medical-therapeutic model in that it focuses on
education rather than treatment, on strengths rather
than problems, and on water safety and swimming
skills rather than facilitation of movement.
The progressive swim models of the ARC and
YMCA guide instructional programs by listing water
safety and swimming skills in a hierarchy. Individuals
build on the skills learned earlier and progress up the
hierarchy much like students do in graded classrooms
in schools. When an organization defines skill pro-
gressions (see appendix B), participants see the big
picture of water safety and skill instruction, and this
minicurriculum serves as a guidepost for progress.
Because of the mandates of IDEA (see chapter
1), an aquatics professional providing service in
the educational model must be more accountable
26 Adapted Aquatics Programming
to parents and caregivers for their children’s educa-
tional performance. Educational aquatics programs
in schools and community agencies often contribute
to a child’s IEP and operate within the educational
model. The aquatics instructor must expect and ask
to be a part of creating the IEP.
The APE service delivery model discussed by
Claudine Sherrill (2004, p. 9) incorporates all of the
required concepts from IDEA for educational program
delivery. This model stresses identifying participants
with needs in the psychomotor area; providing
appropriate assessment; planning, implementing, and
evaluating participants; and providing instruction in
the least-restrictive environment. (Further information
about least-restrictive environment follows. Also see
the sections “Placement, Inclusion, and the LRE” on
page 41 in chapter 3 and “Developing the IEP or
IAPP” on page 77 in chapter 4.)
The social minority model has also greatly influ-
enced the educational model. This model promotes
the philosophy that individuals with disabilities
are different—not defective or inferior, but simply
different. This standpoint tends to provide a more
positive approach to any issue surrounding indi-
viduals with disabilities. Assessment tends to rely on
individualized data, and the goal becomes educating
to empower.
Distinct Components
The distinct components of the educational model
include the focus on learning theory and its appli-
cation to teaching aquatic skills, the notion that an
individual has unique strengths and weaknesses (as
opposed to the general categorization of a person’s
disability in the medical-therapeutic model), the
concept of using the least-restrictive environment
for the acquisition of skills, the development of an
individualized plan focusing on improving skills
rather than on solving problems, and the content of
each session, which focuses on swimming and water
safety rather than therapy.
Learning Theory
Not surprisingly, learning theory is the foundation of
the educational model. Lesson plans control instruc-
tion by listing individual or group goals, objectives,
teaching strategies, and activities for achieving
objectives and for evaluation. Instructors plan each
aquatics session to provide experiences that encour-
age learning through the sequential progression of
acquiring skills. They introduce skills by explaining
the reasons for the skills, demonstrating the skills, and
guiding the participant’s practice of the skills with
appropriate feedback. Instructional strategies, such as
academic reinforcement games, provide participants
with challenges that motivate them as well as help
them test their new skills.
Another aspect connected to learning theory
and therefore important in the educational model
is developmental aquatic readiness (Langendorfer,
Harrod, & Bruya, 1991). This concept recognizes that
individuals come to the pool with a variety of differ-
ent aquatic backgrounds as well as developmental
levels. Instructors (or therapists) need to recognize
that aquatic readiness plays a critical role in an
individual’s willingness to participate in the activi-
ties. Aquatic readiness may be assessed by observing
initial behaviors and by interviewing the swimmer
and caregivers. If an individual is afraid of the water
or lacks readiness in any other way, a sequential pro-
gression of activities for water orientation is recom-
mended. Irrespective of the model, all practitioners
should address readiness.
Needs Assessment
The second distinct component of the educational
model is the focus on assessing individual needs and
thus giving caregivers, significant others, and the par-
ticipant a say in what strengths and weaknesses they
want to address. With this model, providers examine
functional abilities and limitations rather than accept-
ing a medical diagnosis or assigning a disability cat-
egory. Progressing from a medical-therapeutic model
to an educational model, in which providers teach
rather than treat the participant, is an important step
in empowering individuals to assume active roles
in self-actualization, a concept that comes from the
social minority model.
Least-Restrictive Environment
Another aspect of the educational model—one that
resulted from legislation—is the least-restrictive envi-
ronment (LRE). As much as possible, children with dis-
abilities should be placed in the environment that best
meets their needs, provides appropriate socialization
and instructional opportunities, and encourages
full potential while receiving education alongside
individuals without disabilities. Some professionals
believe that individuals with disabilities should (with
necessary supports) be totally included in all regular
aquatics. Individuals should participate in integrated
aquatics programs if they can acquire skills in a group
setting with necessary support. If this is not possible
due to health, physical, emotional, cognitive, or other
reasons, then other placements should be explored
(see chapter 3).
 Models of Collaboration in Adapted Aquatics 27

Individualized Plans Goals that might guide adapted aquatics come

from the educational model’s philosophy of instruc-
The Individualized Educational Program (IEP) for
tion for swimming and water safety. The goals of the
individuals aged 5 to 21 years; the Individualized
program include providing instruction and activities
Family Service Plan (IFSP) for infants, toddlers, and
that improve the following:
preschoolers; the Individualized Transition Plan (ITP)
for individuals over 14; and the Individualized Aquat-
ics Program Plan (IAPP) for adult participants are all • Knowing and appreciating pool rules and safe
distinct characteristics of the educational model. behavior
These plans define the educational goals and provide • Correctly using steps, ramps, ladders, lifts, and
an individualized curriculum that is based on the transfer equipment
student’s needs and desires, the caregiver’s goals, and • Closing the mouth when a wave or splashing
the availability of equipment, personnel, and facilities occurs
(see also chapter 4). • Controlling breathing
Lesson Content • Performing swim strokes
• Performing competitive starts and turns
The content of each session is another distinguishing
factor in programs that use the educational model. • Performing synchronized swimming movements
The instructor must analyze swim strokes to deter- • Competently using a mask, fins, and snorkel
mine which tasks the participant should master. A • Swimming in a tube or life jacket
learning progression based on learning style, on
• Rolling from front to back and vice versa
physical, mental, and emotional abilities, and on task
difficulty must be developed. Moreover, water safety • Inflating clothing for survival swimming
information must be integrated, while skills should be • Changing direction while swimming
linked to their usefulness in fitness, recreation, and • Recovering from the horizontal position
survival pursuits. Aquatic games, stunts, and swim
• Treading water
strokes can be taught using the educational model
of adapted aquatics. • Making a reaching rescue

Goals and Objectives Programs may expand this list to include community
water safety; lifeguard training and instructor skills;
The main goal of any aquatics program following boating, scuba, competitive, and synchronized swim-
the educational model is to teach an individual with ming skills; diving; and water polo.
a disability how to safely enjoy the
aquatic environment (see figure 2.2).
Instruction in aquatic skills facilitates
safe enjoyment. The range of aquatic
skills that can be taught varies among
individuals. In a regular aquatics pro-
gram, instruction proceeds so that all
participants complete the same skill,
such as bobbing in deep water 20 times
or performing a standing front dive off
the pool deck. However, individuals
with disabilities who need prerequisite
Photo courtesy of Monica Lepore

or adapted skills may each finish the

program with different outcomes. A
general aquatics instructor can help
participants accomplish objectives
within a swim class of same-aged peers
by using an adapted aquatics instructor
as a coinstructor or by working with
individuals with and without disabili- Figure 2.2  The careful and proper use of flotation assistance diminishes
ties one on one or in a small group. anxiety while enhancing safety.
28 Adapted Aquatics Programming
Since IDEA identifies aquatics as a specific activ-
ity under its definition of physical education, physi-
cal educators may include aquatics in the physical
education program. Thus, goals and objectives may
include both swimming and nonswimming skills,
such as balancing on one foot, hopping, jumping,
and underwater stunts and running. While these skills
may be typical in land-based physical education,
performing them in the water generates resistance,
which can help individuals be more aware of what
their body parts are doing (see figure 2.3). In Canada,
a program called Aqua-Percept helps individuals do
just this. Aqua-Percept is a prototype program that
strives “to build and maintain confidence; to bridge
gaps in motor development; and to teach each child
to swim” (Fitzner, 1986, p. 8).
The following are examples of typical goals and
objectives for participants in programs guided by the
educational model of adapted aquatics:
Participant Goals
• To improve breath control
• To increase cardiorespiratory endurance
• To improve mechanics of swim strokes
• To improve fundamental locomotor skills
Photo courtesy of Shawn Stevens
Figure 2.3  Physical education activities can be
adapted for the pool.
Participant Objectives
• Participant will improve breath control by
performing 20 consecutive bobs in deep water
each session.
• Participant will increase cardiorespiratory
endurance by swimming the front crawl for 300
yards (274.3 meters) more per session.
• Participant will improve mechanics of swim
stroke by using proper hand placement 75%
of the time during the catch phase of the front
and back crawl.
• Participant will run for 50 yards (45.7 meters)
with coordinated cross-lateral movement 75%
of the time.
As mentioned earlier, the educational aquatics pro-
gram may be used to incorporate objectives typically
taught in an academic classroom. The water can be
used to reinforce and teach words and concepts such
as under, on top of, over, and so on; this is important
for individuals needing concrete, hands-on learn-
ing experiences. Designing total lessons around the
concepts is not required—the concepts are simply
emphasized whenever possible during the already
existing lesson. For example, during the front crawl,
cue phrases such as “elbow up” with a tap on the
elbow can emphasize the word and concept of up.
Sometimes a concept can be initiated in the pool
through special planning and coordination with the
classroom teacher. We encourage planning instruc-
tional units that teach swimming, academics, and
movement all at once.
Settings
The settings in which aquatics programs following
the educational model take place include schools,
community centers, and camps. Many children first
learn to swim during summer camp. Schools provide
educational adapted aquatics as part of the physical
education curriculum to replace or complement the
regular or adapted physical education class.
Sometimes when schools don’t have a facility but
an IEP calls for an educational aquatics program, the
school will subcontract with a community pool to
provide the program. When this happens, the school
will dictate that the program be geared toward the
educational model of service. The school provides
transportation to a community-based facility to fulfill
this requirement.
Providers
Providers of adapted aquatics within the educational
model include general and adapted aquatics instruc-

tors, regular and adapted physical educators, and
occasionally special educators and TR specialists.
General aquatics instructors gain formalized train-
ing in the educational model by attending classes
and passing tests that are given by the ARC, YMCA,
AAPAR of AAHPERD, or National Safety Council.
Aquatics instructors receive cursory lectures about or
brief experiences with individuals with disabilities in
an effort to make these instructors comfortable with
inclusion. Aquatics instructors who have no other
training in teaching swimming and water safety to
individuals with disabilities may gain this training
by working with an experienced coinstructor. We
recommend, however, that formal training from an
agency such as AAPAR of AAHPERD or the YMCA
accompany informal training. This formal training
will help instructors provide safe, effective, and rel-
evant educational aquatics programs and create an
environment in which greater learning and socializa-
tion takes place. Further, formal training will make it
easier to make appropriate decisions regarding each
individual.
The aquatics instructor should receive input from
the school-based physical educator about the indi-
vidual’s motor skills on land and behavior in groups.
The general or adapted physical educator might
recommend as to whether a child could benefit from
a totally inclusive aquatics program or could learn
better in a small-group, one-on-one, or segregated
placement. The general or adapted physical educa-
tor may also teach or reinforce land-based skills
in the water. Consulting, sharing information, and
advocating for aquatics in the IEP are functions the
APE specialist can serve. Thus, the aquatics instruc-
tor teaching in the school setting or collaborating to
provide aquatic services for the school in community-
based settings must understand assessment and the
IFSP, IEP, ITP, and IAPP (see chapter 4). The special
education teacher, although not necessarily versed
in aquatics, may try to use pool time to incorporate
goals and objectives from the academic classroom.
Activities of daily living, spatial concepts, and the
concept of following directions can be easily merged
into the aquatics lesson.
The special education teacher may be a great
advocate for aquatics programming in the educational
setting and may work with the individual in a self-
contained class or learning- or physical-support set-
ting or work as a consultant to the inclusion program.
No matter how much contact the special education
teacher has with the student, valuable information
about the academic level, learning style, and overall
behavior of the student can be provided. Academic
level may not seem to be a concern of the aquatics
instructor, but mental age, reading and comprehen-
Models of Collaboration in Adapted Aquatics 29
sion levels, and concepts being presented in class all
largely affect what and how information is presented
in the pool.
As a team member within the educational setting, a
CTRS may use the educational model when teaching
skill acquisition. The learning of aquatic skills in the
transition from the rehabilitation to community setting
requires the instruction of new skills and the chang-
ing of behaviors. Crossing over the boundaries from
instruction to recreation makes TR (and sometimes
kinesiotherapy) unique.
Important Issues
For each individual with disabilities, the professional
must ask, “What is the most appropriate place for this
individual to learn water safety and aquatic skills,
and who should conduct the instruction?” The most
pressing and controversial issue is total inclusion
versus least-restrictive environment. The educational
approach to aquatics can take place in any kind of set-
ting; thus, the issue of settings should not dictate what
or how learning occurs (see chapter 3). The role of
the regular aquatics instructor in teaching individuals
with disabilities continues to be an unresolved issue.
Regular aquatics instructors with no formal training
find it difficult to integrate the individual with special
needs into aquatics programs. Thus, all participants
with disabilities should have access to an instructor
with formal training in adapted aquatics. An adapted
aquatics specialist does not necessarily need to be
the principal instructor. Assessment, planning, place-
ment, monitoring of instruction and opportunities,
and evaluation of the progress toward individualized
goals and objectives should, however, be done by an
adapted aquatics instructor, adapted physical educa-
tor, or CTRS with aquatics instructor certification.
Whether the instructor, support person, consultant,
assistant, or simply monitor of the plan, a trained
adapted aquatics specialist must be involved.
Recreation Model
Organized recreation in the United States evolved
from concerns for disadvantaged populations living
in urban settings during the industrial revolution.
However, as more affluent populations demanded
and received public recreation services, the mission
moved steadily away from social service programs
for the disadvantaged to recreation programming
for all citizens (Carter, Van Andel, & Robb, 2003;
Smith, Austin, Kennedy, Lee, & Hutchison, 2005).
As a consequence of this shift, the provision of rec-
reation programming for individuals with disabilities
30 Adapted Aquatics Programming
was reduced to isolated facilities and state residential
institutions, where an expanding population of indi-
viduals with disabilities continued to be placed out of
sight and mind of the general population. While there
are numerous definitions of recreation, it is generally
thought of as voluntary participation in a wide range
of leisure activities that are personally and socially
redeeming and provide a balance with work (Cordes
& Ibrahim, 1999; Kraus & Curtis, 2000).
Distinct Components
The recreation model of aquatic services focuses on
activities that are provided in a variety of structured
settings, including public aquatics, commercial
aquatics, corporate aquatics (Cordes & Ibrahim, 1999,
p. 8), and inclusive recreation aquatics.
Public Aquatics
These aquatics programs are typically offered by
nonprofit agencies. Their programs, including leisure
activities or athletic contests at beaches, are designed
to meet both the indoor and outdoor recreational
needs of a diverse group of citizens.
Commercial Aquatics
Aquatics programs in this arena are generally offered
on a pay-for-play basis and are profit driven. They take
place in settings such as exercise clubs and water
parks. Other aquatic venues such as lakes, rivers,
and oceans offer activities that require the rental of
equipment to participate, such as canoeing, kayaking,
windsurfing, parasailing, and jet skiing.
Corporate Aquatics
Another distinct component of recreational aquatics
is corporate swim teams, which compete against each
other in athletic events that fundraise for local affili-
ates, such as the Battle of the Businesses. Some com-
panies provide a pool within their facility or provide
access to local fitness clubs for their employees.
Inclusive Recreation Aquatics
These programs are offered by public and private
agencies for the benefit of populations with special
needs. They are generally offered along a continuum
of services from special to inclusive recreation.
Goals and Objectives
Goals of aquatics programs following the recreation
model include allowing individuals with disabilities
complete access to aquatic activities and to taking
personal risks of their own choosing. In addition,
the programs should provide experiences that nur-
ture individuals to become the best that they can be
physically, cognitively, emotionally, and spiritually.
Recreational participation ranges from lounging in a
home pool to taking swim lessons in a community
pool to paddling in swift water to progressing from
segregated to inclusive (vertical integration) activi-
ties in competitive aquatic events. Depending on
the aquatic activity, the general goals of the program
include the following:
• Functional aquatic skills and water safety
• Positive social interaction
• Escape from routine
• Health and physical fitness
• Elevated self-esteem and confidence
• Creative expression
• Interaction with nature
Settings
Aquatics programs that follow the recreation model
are found in a multitude of settings including pools,
ponds, streams, rivers, oceans, community water
parks, summer camps, recreation centers, develop-
mental centers, and special recreation facilities.
Providers
Those who provide recreational aquatics program-
ming include regular and adapted aquatics instruc-
tors, caregivers, coaches, physical and occupational
therapists, and recreation and TR specialists.
Important Issues
As in the education model, one of the most pressing
issues in the recreation model is where individuals
with disabilities should go to learn recreation skills
and who should conduct the communication. The
issue in the recreation model is inclusive recreation
versus TR. The discord surrounding the recreation
model stems from the internal professional debate
over the foundational philosophy of TR. In the field of
therapeutic recreation, philosophical polarity exists,
and two philosophical points of view have emerged
(Smith et al., 2005). Smith et al. (2005) support the
position that “inclusive recreation (i.e., recreation
including individuals with disabilities) and therapeu-
tic recreation (recreation as a clinical intervention
directed toward treatment or rehabilitation aims)
stand as two separate entities.” In addition, Smith et
al. (2005) write the following:
The National Therapeutic Recreation Society (NTRS),
a branch of the National Recreation and Park Associa-

tion (NRPA), has adopted the position that therapeu-
tic recreation is primarily defined as “the provision
of leisure services for those people who have some
type of limitation.” However, a second position in the
field of therapeutic recreation holds that “therapeutic
recreation should restrict itself to the application of
purposeful interventions employing the therapeutic
recreation process, and should, therefore, relinquish
the provision of community recreation for people
with disabilities to community recreation and parks
personnel.” (Smith et al., 2005, p. 12)
While the debate over the philosophical base of
TR rages on, Bullock and Mahon (1997) and Austin
(2004, pp.170-172) have captured a rationale for the
current discordance by stating that TR is an emerging
profession. A number of models will be presented in
the coming years, and practitioners will select the
model that best represents their agency.
Recreation Options for Individuals
with Disabilities
A major issue in the recreation model is what the
best placement and services are for individuals
with disabilities. Some people believe that a vari-
ety of recreational settings (segregated, integrated,
and inclusive) should be available to match to an
individual’s abilities. However, others believe that all
individuals should participate together in the general
recreation setting. These two concepts are referred to
as least-restrictive environment (LRE) and inclusive
recreation, respectively. Inclusion philosophy refers
to “attitudes and beliefs of acceptance that promote
positive, meaningful integration” (Sherrill, 2004,
p. 104). Inclusive recreation philosophy supports pro-
viding the same acceptance, choices, and opportuni-
ties for all members of the community, so that family,
neighbors, and friends can learn and recreate together
in the same supportive leisure setting regardless of
individual needs and so that all people are provided
with appropriately trained recreation personnel. The
authors believe there should be a continuum of rec-
reational opportunities; however, not all options on
a continuum are inclusive. At this point the authors
take the position that recreational adapted aquatics is
a subcomponent of special recreation. The number of
instructional options is less important than ensuring
that students participate in the most inclusive aquat-
ics program that is still conducive to their safe and
successful participation. Depending on the services
available in a community, a participant in recreational
adapted aquatics will encounter various leisure envi-
ronments. Schleien, Ray, and Green (1997, p. 12)
have outlined a continuum of community recreation
options and services for individuals with disabilities
Models of Collaboration in Adapted Aquatics 31
(see figure 2.4). We have modified this continuum
to fit our discussion. The continuum includes the
following opportunities for involvement:
• Noninvolvement occurs when a community
fails to provide for the needs of its members with dis-
abilities. When community recreational professionals
fail to include citizens with disabilities when assessing
the needs and interests of all community members,
this segment of the community passively observes
leisure activities rather than actively participating in
them. This passive observation places an already at-
risk population in jeopardy of further social isolation
and deteriorating psychological and physiological
health. Another barrier to including people with
disabilities may be the misconception by recreation
leaders that the leisure needs of this population are
already being met by other service providers, adapted
sports, and advocacy agencies.
• Segregated, or special, recreation participa-
tion often is dictated by the nature of the activity
or its required level of skill or social competency.
Participation in segregated activities may be an end
in itself (sport competition), a reflection of participant
desires (socialization with others with like abilities),
Inclusive
(full
involvement)
nt
me
iron
env
Integrated
(mixed-ability groups)
ve
i
rict
est
st-r
Lea
Segregated
(individuals with disabilities only)
Noninvolvement
(noninclusion of individuals with disabilities)
Figure 2.4  A continuum of recreation options for indi-
viduals with disabilities.
Adapted, by permission, from S. Schleien, M. Ray and F. Green, 1997, Community
recreation and people with disabilities: Strategies for inclusion, 2nd ed. (Baltimore, MD:
E3344/Lepore/fig.2.4/278251/alw/r4
Paul H. Brookes Publishing Co., Inc.), 12.
32 Adapted Aquatics Programming
or a temporary measure until the individual possesses
the prerequisite skills for inclusive recreation. While
existing criteria for placement in segregated aquat-
ics activities need to be further defined, this is the
appropriate participation level for participants with
the most severe disabilities, who require the greatest
support. In addition, some psychosocial supports and
functional lifetime activities are best learned from
homogeneous populations.
• Integrated leisure provides individuals with
disabilities opportunities for participation in general
community leisure activities. While participation
may require support from specialized personnel
or services, it is with a heterogeneous population.
Integrated participation draws the most questions
from general recreation providers. This level may
involve reverse mainstreaming, in which traditionally
segregated activities are modified to accommodate
participation by individuals without disabilities.
While there are advantages and disadvantages to
this approach, it adds another vehicle for recreation
professionals to use in facilitating positive interaction
between populations who too often have viewed each
other from a distance.
• Inclusive leisure programming is also referred
to as zero exclusion and should be the ultimate goal
of all recreation service providers. It is the front
line of simultaneous recreation programming for all
community members. It is where academic theory
meets applied reality and where stereotypes take on
a human element. At this level participants with dis-
abilities can freely choose what activity they desire
and receive the same amount of attention as any
other participant. The participants pursue their goals
without architectural or programmatic concerns, skill
limitations, or other psychosocial concerns.
Transdisciplinary Model
The foundation of any professional service is its phi-
losophy. Although there is no universally accepted
process for developing a philosophy, a philosophy
can be defined as a collection of learned values,
beliefs, and preferences (Edginton, Jordan, DeGraaf,
& Edginton, 1995). Professional practice evolves
from philosophical tenets that are used to guide
professional behavior. Every individual operates
from a personal foundation of knowledge, beliefs,
and values that reflect her perspective. Because our
philosophies dictate what we do and how we feel,
we as adapted aquatics specialists should participate
in self-examination to find our personal philosophical
viewpoints. Such examination will assist in setting
priorities, making decisions, and assessing problems.
By knowing our personal philosophy, we can enhance
our communication by focusing on collaboration.
The concept of collaboration is ambiguous due to
numerous definitions made by diverse entities in the
corporate, medical, political, educational, and human
service professions. Understandably, professionals,
parents, and participants may be confused by the
various definitions in practice today. For example,
Seaman, DePauw, Morton, and Omoto (2003) define
collaboration as “a process in which all participants
have an opportunity to facilitate learning” (p. 5),
while Kelly (2006) defines collaboration as “working
jointly with others to accomplish a common goal such
as making decisions or implementing programs or
assessment plans” (p. 181). The word collaboration
is far more than just a synonym for consultation or
cooperation (Friend & Cook, 2003; Sherrill, 2004,
p. 74). Collaboration suggests how the interpersonal
relationships transpire between team members and
includes the various routines the team members use
for communicating. These interpersonal relationships
and ways of communication define collaboration.
Individuals who practice collaboration maintain
underlying core values and project behaviors that
facilitate working relationships and shared responsi-
bility for success, resulting in all participants learning.
For example, Friend and Cook (2003) define interper-
sonal collaboration as “a style for direct interaction
between at least two co-equal parties voluntarily
engaged in shared decision making as they work
toward a common goal” (p. 5).
This style of interaction cannot survive in isolation
and must communicate how collaboration is occur-
ring. Collaboration manifests itself only when people
are acutely involved in the specific process and all
parties believe that even the most challenging issues
can be resolved. Effective collaborators hold certain
convictions and interact with others for the benefit of
aquatics participants with disabilities. The underly-
ing belief that all students can learn and that teach-
ers share responsibility for their students’ success is
critical (Choate, 2003). Table 2.1 lists characteristics
of effective aquatics collaborators (personnel) and
collaborative teams.
Because legislation provided access to various
services in the United States, including educational
programs, recreational activities, and vocational
opportunities, human services personnel emerged
to help facilitate each of these services, leading to
the development of the transdisciplinary team (also
called the collaborative or cross-disciplinary team)
during the 1970s, 80s, and 90s.

Table 2.1
Collaboration Characteristics
Characteristics of aquatics collaborators
Understanding that people learn in different ways
Understanding that people communicate in various ways
Openness to new ideas and approaches
Confidence in own knowledge
View of others as equally competent
Willingness to share resources
Participation in decision making
Accountability for successes and challenges
Willingness to listen to others
Because of the many professionals who were all
striving to help individuals with disabilities become
the best they could be, conflicts arose as to what
the priorities are in a person’s life. In the 1970s, the
multidisciplinary team (M-team) of service, now
often referred to as the multifactored team, became a
popular method for developing comprehensive plans
for remediation (Sherrill, 2004). Professionals in a
multidisciplinary team share their assessment results,
goals and objectives, and progress reports. Members
of the M-team know what the others are trying to
accomplish and are aware of the methods the others
are using. Often, professionals employing this model
discuss and recommend additional services that the
individual may need.
In the 1980s, interdisciplinary service began to
develop. The interdisciplinary model builds on the
multidisciplinary model to promote collaboration
among professionals in planning and implementing
programs. These professionals may present assess-
ment information at a team meeting and together
agree on goals, objectives, and strategies in order to
act more as a unit in their service provision. If you
are an aquatics instructor cooperating within this
model, you are responsible for incorporating the other
professionals’ goals into your program. For example,
if the team has specified that the individual needs to
develop left–right discrimination, you must provide
appropriate feedback and skill development during
instruction. In this way, individuals with disabilities
receive more comprehensive services in aquatics.
Recognizing that the unidisciplinary model had
failed and that the multidisciplinary and interdisci-
plinary models were not doing enough in providing
aquatics for individuals with disabilities, Dulcy con-
ceptualized using a collaborative model for aquatics.
As seen in figure 2.5, Dulcy (1983a) demonstrated that
Models of Collaboration in Adapted Aquatics 33
Characteristics of aquatics collaborative teams
Respect for due process of parents and caregivers
Ethical leadership
Open communication
Common goals
Conflict resolution
Mutual trust and respect
Perception of team as united
Parity among members
Open documentation
the unidisciplinary model has limited benefits. The
division of aquatics programming into therapeutic,
recreational, and educational approaches does not
sufficiently meet the needs of participants and may
cause a cycle of problems. As previously discussed,
in the medical-therapeutic model, therapists often
sacrifice fun for exercise related to specific goals, so
that patients with cognitive difficulties lose interest
and need motivation through fun activities. In the
recreational model, professionals providing special
recreation lack medical input in regard to diagnosis,
functional abilities, and developmental needs. In the
educational approach, instructors may be unaware
of therapeutic positioning. Although the TR approach
appears to be closely aligned with a transdisciplinary
approach, the numerous TR service models confuse
both TR specialists and associated professionals.
Major advantages of the transdisciplinary model
include the practice of intra- and interdisciplinary
collaboration, individualized program development
(see figure 2.6), and recognition of the value of pro-
gram input from all other models.
Distinct Components
The distinct components of the transdisciplinary
approach are the release of roles by each member of
the team, the integration of each service within an
existing program, and a view of the person as a whole
rather than as a list of separate needs.
Role Release
Role release is a method of introducing a specific
discipline to other members on a collaborative team.
Initially, it consists of role extension, in which team
members describe their role; role enrichment, in
which team members share important information
34 Adapted Aquatics Programming

Vicious cycle of problems

in aquatic programs
Input Unid
isci
plin
a ry

Lack of changes
in practice
Unidisciplinary professional
Unidisciplinary
training
attitudes
Lack of changes
in training

Aquatics programs

Recreational Therapeutic
Output

Lack of, or deficient knowledge about,

Safety problems safety, diagnosis, and functional ability
Decreased use
Lack of fun activities,
Decreased efficiency
development of recreational skills

Decreased
communication

Figure 2.5  Failure of the unidisciplinary E3344/Lepore/fig.2.5/278253/alw/r2

model.
Reprinted, by permission, from F. Dulcy, 1983, “Aquatic programs for disabled children,” Physical and Occupational Therapy in Pediatrics 3(1): 18.

about basic practices in their discipline with regard • The aquatics specialist teaches the other team
to a participant; and role expansion, in which team members about the specific methods and ben-
members explain how others can use their practices efits of teaching swim strokes, water safety skills,
in different settings. As the team works together, role and aquatic games to program participants.
exchange and role support take place. When pro-
• The aquatics specialist learns the functions of
fessionals practice role exchange, they implement
the other disciplines and has enough knowledge
techniques from other disciplines. In role support,
to integrate other curricular areas and therapeu-
team members support each other as they take on
tic methods into the aquatics program.
each other’s roles while working with a specific
individual (Woodruff & McGonigel, 1988). An aquat- • The aquatics specialist occasionally includes other
ics specialist might participate in this process in the team members in pool sessions for group assess-
following ways: ment or for teaching and therapy sessions.

d el Ed
uc
mo at
n i
tio
on
rea
mo
Rec
del
Intra- and
interdisciplinary
collaborations
for individualized
program
development
Transdisciplinary model
Individualized program input from all
relevant models
Figure 2.6  Success of the transdisciplinary model.
E3344/Lepore/fig.2.6/281125/alw/r2
• The aquatics specialist becomes familiar with
medical and academic classroom terminology
in order to communicate more effectively.
• The aquatics specialist functions as a bridge
among recreational, educational, and therapeu-
tic aspects of swimming and water safety.
• The aquatics specialist provides opportunities
for individuals with disabilities to practice and
generalize academic concepts, activities of
daily living, leisure choices, and motor skills.
• The aquatics specialist is aware of the interac-
tion of the individual with the environment
and uses many sources of professional input
for modifying that environment.
Thus, the transdisciplinary approach differs from
the multidisciplinary approach in that team members
truly understand each other’s roles, having learned to
function in each other’s capacities.
Inclusion
Including each professional, service, and the benefits
of that service within an existing program can be part
of the collaborative process. For example, rather than
meeting separately with a participant, the therapist
Models of Collaboration in Adapted Aquatics 35
enters the pool with the aquatics instructor and
facilitates therapeutic goals in that setting. In this way,
the aquatics instructor and therapist (or the special
education teacher) can maximize effectiveness, share
ideas, and see goals in progress. The participant ben-
efits by having medical, therapeutic, educational, and
recreational goals incorporated into one session. In
this model, the therapist doesn’t work for 5 minutes
on one aspect and then wait while the teacher spends
5 minutes on another aspect. If the participant walks
for a warm-up, the therapist or aquatics instructor
gives a prompt to encourage good posture while
engaging in appropriate social interaction. These three
separate behaviors—warm-up, posture, and social
interaction—receive intervention from the treatment
team, so that the participant practices skills from other
disciplines in a single setting: the pool.
Phenotypic Assessment
Phenotypic assessment refers to observable, manifest
characteristics that provide a clear analysis of what
the individual can and cannot do. In the past, profes-
sionals providing therapy, education, and recreation
to individuals with disabilities worked in isolation.
Focusing on their own work and goals, they lost sight
of the whole child or adult. The collaborative model
champions the idea that an individual with a disability
cannot be adequately served when dissected into parts
such as the brain and the legs. Instead, the professional
working with the participant must understand the need
and incorporate cognitive, social, physical, and affec-
tive (emotional) goals within each activity.
Goals and Objectives
The goals and objectives of the transdisciplinary
model include the goals of the three models pre-
viously described, focusing on transdisciplinary
cooperation. The team of professionals, along with
the caregivers and the participant, prioritizes goals
and provides collaborative input. Goals for programs
that have adopted a transdisciplinary approach might
include the following:
• To develop functional walking patterns during
aerobic aquatics classes
• To maintain vital lung capacity during breathing
exercises and swim strokes
• To increase range of motion while swimming
laps
• To improve transfer skills while entering the
pool
• To develop socialization skills during water-
jogging
36 Adapted Aquatics Programming
• To increase cooperative behaviors while waiting
in line to pay or present a membership card at
the pool
• To improve arm and shoulder strength while
treading water
• To decrease abnormal muscle tone during swim
instruction
• To increase awareness of aquatic opportunities
for leisure pursuits
The following lists include examples of goals
and quantitative objectives for participants within
programs conducted under the transdisciplinary
model:
Participant Goals
• To improve posture through aquatic activities
• To improve communication and cooperation
during swim class
• To develop lifetime leisure skills of swimming
and water aerobics
• To increase self-confidence through learning
to dive
• To understand the relationship between swim-
ming and fitness
• To maintain vital lung capacity through per-
forming rhythmic breathing during the front
crawl
Participant Objectives
• Participant will keep head and neck aligned
while treading water for 1 minute.
• Participant will wait for a turn and respond “me”
when it is his turn, 75% of the time.
• Participant will learn two swim strokes and two
water aerobics steps and perform them indepen-
dently for 100% of the time during warm-up.
• Participant will show increased self-confidence
by performing a standing front dive from the
diving board.
• Participant will demonstrate an understanding
of the relationship between swimming and fit-
ness by correctly answering several questions
pertaining to that issue.
• Participant will demonstrate maintenance of
vital lung capacity by performing rhythmic
breathing without stopping during 100 meters
of the front crawl.
As you can see, it is important to go beyond a
single-minded (unidisciplinary) medical-therapeutic,
educational, or TR focus. Coordinating efforts among
various professionals allows both adult and juvenile
participants to practice recreational, educational, and
therapeutic skills in a natural setting. In this trans-
disciplinary scenario, the team of professionals can
achieve its primary objective: to improve or maintain
functioning of the individual. Trying to meet all the
objectives that a participant is working on in her
life during one session is not the intent. Rather, the
program incorporates a variety of objectives in order
to meet specific long-term goals prioritized by the
team and the participant. Thus, in this model, all the
professionals involved have a better understanding of
the overall goals and objectives for each individual
they serve.
Settings
The cooperative nature of the transdisciplinary model
opens the doors to many natatoriums. Transdisci-
plinary programs may take place anywhere a pool is
found: community centers, hospitals, schools, resi-
dential living facilities, or treatment centers.
Providers
Specialists involved in a transdisciplinary model of
aquatic service may include regular and adapted
aquatics instructors, regular and adapted physical
education specialists, physical therapists, physical
therapist aides, occupational therapists, occupational
therapist aides, speech and language pathologists,
recreation specialists and CTRSs, rehabilitation or
physical medicine physicians, kinesiotherapists,
special education or regular education teachers or
aides, play therapists, parents or caregivers, nurses,
and coaches.
Important Issues
Significant issues involved in making the transdisci-
plinary model work are communication among team
members, change in traditional unidisciplinary train-
ing, and legal issues involved with role release.
Communication
Not surprisingly, extensive communication is integral
to the transdisciplinary model. As mentioned earlier,
role extension, expansion, and release are critical to
success. Communication goes beyond reporting what
has been done with an individual during a session.
Sharing concerns with one another and including
participants and significant others in discussions of
successful approaches, skill sequences, and environ-
mental influences are crucial to the success of the
collaborative model.
 Models of Collaboration in Adapted Aquatics 37

Traditional Unidisciplinary Training sulting an aquatics instructor. Using progressions for

Institutions of higher education and community
organizations that train recreation personnel, special
educators, therapists, and aquatics personnel must
include transdisciplinary methods in their curricula to
foster this philosophy, rather than the unidisciplinary
approach. Believing that the approach used in one
discipline is the only and best approach and engaging
in turf wars inhibit cooperation. Some professionals
even attempt to deter others from infringing on areas
that they believe to be their exclusive domain. As
professionals, however, we must reinforce mutual
goals and relinquish control over some skills that
can be safely and successfully carried out by others
under supervision.
Legal and Safety Issues
Although we recommend the transdisciplinary
approach, it does have legal and safety constraints
that should be observed. Legally, an aquatics special-
ist is not a therapist and therefore should not provide
manipulations, such as massage, joint compression,
and passive range-of-motion exercises, with medi-
cally diagnosed individuals. Moving healthy limbs
for the purpose of tactile or kinesthetic teaching is
acceptable, however. Likewise, therapists and educa-
tors who are not trained in water safety instruction
should not teach swimming, work with frightened
swimmers, or move into deep water without con-
teaching water safety is imperative for safe aquatics
programming.
Summary
Whatever model an aquatics program follows, the
primary program goal must be facilitating the safe
acquisition of aquatic skills by providing professional
service in the most inclusive environment. To accom-
plish this goal, program providers must formally assess
each participant and plan a program that meets the
individual’s needs, with additional service providers
when necessary. In order to foster learning, the pro-
viders may need to refer the participant to another
program. Since each participant and program must
constantly be formally and informally evaluated,
appropriately trained and certified professionals
must be involved in order to accomplish program
and individual goals.
The best way to meet the needs of each individual
is to maintain the tenets of collaboration, providing a
team of professionals collectively using their experi-
ence to pool resources, knowledge, and expertise.
Extensive communication, role sharing, and attention
to the legal issues of role release are important factors
that the program must address in order to comprehen-
sively and effectively deliver aquatic service.

Chapter 2
Review 1. Define what a program model should convey.
2. What are four models describing the provision of aquatics programs?
3. Define the term philosophy and its application to aquatics program
development.
4. Define the term collaboration and list the desired characteristics of team
and individual collaborators.
5. Define the terms role expansion, role exchange, and role release as uti-
lized in the transdisciplinary model.
6. Describe the least-restrictive environment (LRE).
7. Discuss total inclusion versus LRE in community recreation aquatics pro-
grams.
This page intentionally left blank.
 3
Inclusion and the
Least-Restrictive
Environment

M r. Colt stood in line on the first day of swim school registration just like the
other 50 parents, although he was surely more anxious than the others. His
11-year-old daughter Sandy has Asperger’s syndrome, a pervasive developmen-
tal disability that affects her ability to process sensory information, make sense of
interpersonal relationships, focus on specific nonverbal cues, indirectly learn from
her environment, and adequately control her emotions.
Mr. Colt is nervous about registering Sandy because he is not sure he wants to
divulge her disability right from the start, but he knows that Sandy needs a smaller
group with a higher teacher-to-student ratio and a patient instructor who will teach
to Sandy’s learning style and give her ongoing cues to remain on task and stay
with the group. Sandy also needs extra safety monitoring and needs the instructor
to escort her from the lesson directly to her parents’ waiting hands. Mr. Colt is also
worried that if he reveals Sandy’s disability the swim school will reject his daughter,
as other community agencies have. The instructors at the last aquatics facility he
tried said that they did not know how to teach children like Sandy. And finally,
Mr. Colt knows that an inclusive environment is good for Sandy—she performs
better when surrounded by peers with on-task behaviors, good motor skills, and
(continued)

39
40 Adapted Aquatics Programming
focused attentions. He believes that inclusion in community and school classes is
right for Sandy as long as it is conducive to her learning. But will this swim school
be a good inclusive experience or one that is fraught with strife and ends in the
inevitable phone call from the aquatics director saying that Sandy does not fit
into the general aquatics curriculum?
I nclusion in general educational, vocational, rec-
reational, and social settings is one of the most
emotional issues among people with disabilities.
Inclusion is the philosophy and practice of educat-
ing individuals with disabilities in general programs
and classes. Inclusion is not just a place but also a
belief that all individuals can and should benefit from
participation in “the range of possible programs, set-
tings and activities available to everyone” (Kasser &
Lytle, 2005, p. vii).
As we have previously noted, the ADA guarantees
that private places in the public eye will provide indi-
viduals with disabilities reasonable accommodations
and access to services, while the IDEA mandates sup-
port services for people with disabilities in general
educational programs. We discuss these concepts in
this chapter as they relate to inclusion, and we iden-
tify issues regarding inclusion and the LRE, including
the following:
• The placement of individuals with disabilities
• The continuum of appropriate placements
• The prerequisites to successful inclusion
• The development and maintenance of success-
ful inclusion groups
When looking at inclusion and the environment
where a person best learns aquatic skills, answering
the following questions should help instructors, par-
ticipants, parents, significant others, and therapists
decide on placement in aquatics programs. Keep
them in mind as you study this chapter.
• How many of the participant’s goals and objec-
tives match what takes place in the general
aquatics program?
• Can the participant follow the rules within the
general aquatics program so as not to compro-
mise the safety of all?
• Is there an age-appropriate class available?
• Does the placement provide an emotionally
and physically safe environment?
• Is the ultimate goal of the placement to participate
in aquatic activities in an integrated setting?
• Does the placement meet other goals, such as
recreational or therapeutic goals, in addition to
instructional goals?
Chapter Objectives
From this chapter, you will learn the
following:
* The issues surrounding placement, inclu-
sion, and least-restrictive environment
(LRE) in the aquatic setting include ques-
tions of safety, appropriate assessment
options, and philosophical concerns.
* Placement and service options available
for swimmers with disabilities include the
fully included setting with appropriate
supports, the segregated setting, and
several options in between.
* The prerequisites for successful inclusive
aquatics programs and classes include
the elimination of architectural, adminis-
trative, and attitudinal barriers.
* Specific considerations for developing
and maintaining successful inclusion
groups include instructor preparation,
identification of learning and physical
supports, group age and makeup, and
framework for task preparation.
* Basic ideas for utilizing activities to facili-
tate inclusion groups include planning
developmentally appropriate games
and gearing activities to the appropriate
age group.
* Considerations for selecting activities for
various age groups in aquatics for swim-
mers with disabilities include knowing the
physical, social, and cognitive charac-
teristics of a variety of age groups and
applying these characteristics to activity
selection.

Placement, Inclusion,
and the LRE
The concept of placement comes from school-based
educational services for individuals with disabilities
from birth to age 21, but placement, as a concept,
also has implications in the adult services realm.
When an individual with a disability seeks entrance
into an aquatics program, you should discuss the
placement and support options with caregivers and
the swimmer himself if appropriate. The discussion
should center on previous experience in aquatics
and swim classes, behavior in groups, learning style,
ability to take direction, safety and medical issues,
and family goals for the experience, including sug-
gestions gleaned from former experiences. Although
the least-restrictive setting for instructional swim-
ming is a class of swimmers without disabilities in
the general aquatics program and educational law
(which applies to school-based programs) mandates
instruction provided alongside peers without dis-
abilities to the maximum extent possible, there may
be many reasons an individual with a disability might
start in a segregated swim group (of only swimmers
with disabilities). Therefore, a visit to the proposed
inclusive setting followed by discussion among the
caregivers, general swim instructor, and adapted
aquatics instructor is warranted before placement in
any kind of segregated group.
The participant, caregiver, or aquatics instructor
(you) may suggest that a participant undergo assess-
ment before beginning the class in order to determine
if she needs support services to enhance learning.
Remember, individual assessment and review is an
integral concept within the ADA and IDEA. Thus, as
an aquatics instructor you should provide an indi-
vidual assessment and follow-up meeting in order
to discover the most educational, inclusive, safe, and
appropriate aquatic setting. Ensure that you do this on
a case-by-case basis without stereotyping the person
according to his disability.
Use the assessment to help determine if support
is needed in the general aquatics group, if additional
adapted aquatics sessions are needed in a segregated
or one-on-one setting, or if placement in the general
aquatics group is not feasible at this time. There are
several ways to approach the issue of where and how
to educate individuals with disabilities. In this sec-
tion we look at three ways: full inclusion (see figure
3.1a), inclusion as home base (see figure 3.1b), and
continuum of placements (see figure 3.1, c-d). With
full inclusion, the swimmer is placed in the class with
same-aged peers in the program closest to home, and
an array of services is brought to the swimmer within
Inclusion and the Least-Restrictive Environment 41
the fully inclusive class. Using an array of services that
supports the inclusion of individuals with disabilities
in high-quality educational, recreational, social,
and work settings has been touted by the National
Council on Disability (NCD) (1994), by the Associa-
tion for Persons with Severe Handicaps (TASH), and
by Schools for Everyone (SAFE) (U.S. Department
of Education, 2002). These services might include
professionals such as paraeducators (instructional
aides), behavior specialists or therapeutic support staff
members, and adapted aquatics instructors, as well as
equipment changes or additions and changes in the
objectives or curriculum for that student. With the full
inclusion method, students are never removed from
the class, as additional help, changes, modifications,
and support are provided directly within the general
swim group.
The second method of looking at placement is
inclusion as a home base. Here, the swimmer is
placed in the class that her same-aged peers are in,
but if part of the class is not safe or appropriate and
support within the class is not enough for the swimmer
to successfully learn, the swimmer is moved out of the
group to work on other skills in a different setting. For
example, if a person who is medically banned from
diving is in a group, while the group covers diving the
student might be assigned to another group or even
assigned to an adapted aquatics group.
The third approach to placement does not directly
place the swimmer in an inclusive setting, but hope-
fully leads to an inclusive setting. This approach,
which contrasts to the previous two methods, involves
the continuum of alternative environments, a term
historically used to denote the placements and
services that lead up to fully included experiences
within general educational or recreational settings.
Sometimes called the continuum of placements or
continuum of services, this philosophy is encour-
aged by the Council for Exceptional Children (CEC)
and the Learning Disabilities Association (LDA) (U.S.
Department of Education, 2002). CEC and LDA
believe that totally inclusive settings should not be
the only available learning environments for people
with disabilities. We support placement in the setting
that is as inclusive as possible while providing the
best learning situation for the swimmer. This place-
ment is based on the assessment results and the team
discussion. In an academic classroom, this placement
would be noted on the IEP, the plan that is mandated
for children with disabilities who are in school. If
parents and caregivers have a say in the education of
their child and service delivery professionals strive to
empower individuals with disabilities to make their
own choices, then no justification exists for only one
placement option (i.e., only inclusive setting). In the
24th report to the U.S. Congress on IDEA in the 1999-
 a

c d

Figure 3.1  (a) Services are brought to the swimmer with a disability within the fully inclusive setting. (b) After beginning
in the inclusive setting, this swimmer is given additional instruction parallel to the group. (c) One rung on the continuum
ladder might be small groups of children with disabilities in a segregated setting. (d) A placement on the continuum
ladder may be in a one-on-one setting.

42

2000 school year, approximately 95.9% of students
with disabilities were in general school buildings,
and 47.3% of these students were served outside of
general education for less than 21% of the day (U.S.
Department of Education, 2002). These statistics show
a definite trend toward inclusive environments, but
let us not forget the 52.7% of these students who had
needs that required them to spend most or all of their
time in segregated settings outside the general edu-
cation class. We must proceed with caution before
generalizing these statistics to the aquatic setting since
data are unavailable for aquatics inclusion.
Although the inclusive setting is the LRE (the
setting that provides unlimited access to peers in
the general aquatics programs and classes), when
a person cannot learn in this environment due to
distractions, such as too many students in the group,
too many people in the pool, or too much movement
in the pool; when the objectives of the class and the
IEP goals do not coincide; or when the swimmer is
at a completely different skill level (i.e., is very afraid
of the deep end and peers are in a diving unit), then
the inclusive setting is not the LRE. The LRE should
be synonymous with the placement in which the
individual learns best. When you carefully match the
ability of the participant with an appropriate aquatic
learning environment, the participant will success-
fully attain swimming and water safety skills. Natu-
rally, the correct environment should have equipment
that is adapted to the needs of the individual, trained
support personnel, and an instructional level that is
commensurate with the participant’s learning abil-
ity. It should emphasize individualized instruction,
ensure the safety of all participants, provide age-
appropriate social interaction, and enable active
participation instead of passive spectatorship (Auxter,
Pyfer, & Huettig, 2005).
The place where the swimmer can learn what is in
the class goals or in their IEP becomes the LRE. Some
individuals might need smaller groups, more sterile
environments, additional space and equipment,
greater teacher-to-student ratios, different delivery of
reinforcement, medical supervision, or a safer envi-
ronment. They may be more successful in a setting
that falls along the continuum of available services
and placements, such as a partially segregated group
(a small group sharing space with the larger group),
a reverse mainstream group (a group focused on
individuals with disabilities that also includes indi-
viduals without disabilities), or a separate class in a
segregated facility in which the physical environment
(air and water temperature, pool depth, and overall
physical comfort level) is more appropriate than that
in a community-based integrated facility.
Inclusion and the Least-Restrictive Environment 43
We believe in providing the aquatic setting in
which an individual learns best—regardless of
politics. You should always carefully examine the
assessment results, drawing conclusions that serve
the individual and not someone else’s ideals. While
socialization and integration are important, these
should not be the overriding factors driving placement
in a program that stresses safety and physical skill
acquisition. The vital question to ask when looking
for an individual’s proper placement within a range
of aquatic opportunities is, “Where will that person
safely and successfully learn swimming and water
safety skills that is parallel to or within the general
aquatics class?” This approach takes into account
opportunities for acquiring the aquatic skills that indi-
viduals without disabilities typically learn in a setting
that is as similar as possible to the setting in which
participants will use these skills in leisure pursuits.
Finally, when placing an individual you must consider
his health and safety as well as the health and safety
of others in the potential group.
Don’t let yourself get lost in the concepts of appro-
priate placement, continuum of services, inclusion,
and LRE. Concentrate on seeking the aquatic setting
that best facilitates learning for the individual. Avoid
favoring one particular philosophy of placement,
thereby causing a disservice to individuals with dis-
abilities. The development of swimming and water
safety skills depends on a program that uses a flexible
curriculum, is conducted by informed professionals
who provide the best environment for each individual
regardless of educational fads, and accommodates
all participants safely and successfully. This is where
using the continuum of placements can truly help you
provide the best environment for each participant.
Continuum of Placements
Since we believe that the continuum of placements
works well in aquatics programs, in this section we
discuss what type of placements might be included
in this continuum. If the formal assessment of aquatic
readiness, your professional judgment, the parental
and participant input, and the preparticipation visit to
the general group setting lead you to determine that
the general aquatics class is not the appropriate setting
for the individual, consider some of the setting options
shown in figures 3.2 and 3.3. Your program may not
currently offer a variety of placements within a particu-
lar aquatics program, but if you encounter an individual
who will benefit from an alternative placement, you
should encourage and pursue such placement.
44 Adapted Aquatics Programming

Continuum in Educational Settings tunities for relationships to develop between people

Block and Krebs (1992) view settings for general
physical activity not as a continuum of placements
but as a continuum of support. We have adapted their
model by replacing physical education with aquatics
(see figure 3.2).
This continuum of support revolves around the
belief that an integral part of all learning is teaching
individuals with and without disabilities together.
Most of the support in this model comes from reverse
inclusion. Reverse inclusion allows participants with
disabilities to work one on one or in small groups in
semi-integrated settings. Having swimmers with and
without disabilities share pool time provides oppor-
with diverse abilities.
The continuum of alternative placements is a series
of placements that are sequenced from most restric-
tive (limited or no interaction with peers without dis-
abilities) to least restrictive (full interaction with peers
without disabilities) (see figure 3.3). The fundamental
belief about the continuum is that an individual must
possess certain prerequisites in order to be truly suc-
cessful in certain settings with her peers. Aquatics
programs that use a continuum of placements may
begin students in less inclusive settings so that they
can learn basic skills, and then promote them when
they have acquired the skills necessary for success
in the next stage of the continuum.

Level 1 No support

• Swimmer makes necessary modifications.

• General aquatics instructor makes necessary modifications for student.
Level 2 Consultation with adapted aquatics instructor

• Instructor recommends that peer tutor watches out for swimmer.

• Instructor recommends that peer tutor assists swimmer.
• Instructor recommends that paraprofessional assists swimmer.
Level 3 Direct service provided by adapted aquatics instructor

• Adapted aquatics instructor works as coteacher in general aquatics class.

• Adapted aquatics instructor works with student one on one within general
class.
• Adapted aquatics instructor intervenes only as necessary.
Level 4 Part-time adapted aquatics and part-time general aquatics

• Student has a flexible schedule with reverse inclusion.

• Student has a fixed schedule with reverse inclusion.
• Student in a segregated aquatics programs attends a general aquatics
program once a month.
Level 5 Reverse inclusion in special program

• Students without disabilities come to a segregated adapted aquatics pro-

gram 2 to 3 times a month for reverse inclusion.
• Students with and without disabilities meet at a community-based aquatics
facility and work out together.

Figure 3.2  Adaptation of continuum of support for regular aquatics.

Adapted, by permission, from M.E. Block and P.L. Krebs, 1992, “An alternative to least restrictive environments: A continuum of support to regular physical education,” Adapted Physi-
cal Activity Quarterly 9(2): 104.
 Inclusion and the Least-Restrictive Environment 45

Placement is based on the following:

1. Swimmer’s needs
2. Assessment
3. Programming
4. Facilities
5. Normalization process

Full-time aquatics
Team teaching
Full-time placement placement in general
between adapted
in self-contained aquatics—
aquatics and
adapted aquatics modifications by
general aquatics
program general instructor if
instructors
necessary

Combination of General aquatics

adapted aquatics program with
and general adapted aquatics
aquatics program consultant

Figure 3.3  Adaptation of Eichstaedt and E3344/Lepore/fig.3.3/278255/alw/r3

Lavay’s LRE model.
Adapted, by permission, from C.B. Eichstaedt and B. Lavay, 1992, Physical activity for individuals with mental retardation: Infancy through adulthood (Champaign, IL: Human Kinet-
ics), 177.

Continuum in Recreational
Settings
Although the models by Eichstaedt and Lavay and
Block and Krebs that have been presented were
devised for individuals with disabilities receiving
services within the schools, these models provide
the cornerstone for nonschool, community, rec-
reational, and transitional (from school to leisure)
programs. Individuals who have disabilities must be
prepared for life in the community, and planning for
that preparation must begin within the IEP when the
individual turns 16 (or younger if the IEP team recom-
mends it). This transition plan within the IEP should
provide goals and objectives for how the individual
will use learned skills in community facilities. Once
students graduate, they are unlikely to carry over skills
from school, hospital, and residential settings unless
programs in the community mimic those settings.
Students moving to community aquatic settings need
alternative placements, supports within the general
aquatics programs, and adapted aquatics instructors
who provide quality assessment, program modifica-
tions, and continuing consultation or hands-on direct
service.
In 1998, Devine and Broach discussed aquatic
inclusion in community programs in an article in
Parks & Recreation. They described the research by a
46 Adapted Aquatics Programming

joint committee of the American Park and Recreation

Society and the National Therapeutic Recreation Soci-
ety. The committee explored the status of inclusion
in parks and recreation programs across the United
States, and Devine and Broach applied the findings
to aquatic recreation programs. In general, barriers
to inclusion included administrative, physical, and
attitudinal barriers. Adopting a model of service is
a start to revising the policy for inclusion in a com-
munity aquatics facility. The models presented here,
from Carter, Dolan, and LeConey (1994) and from
the Canadian Red Cross (1989), attempt to go beyond
meeting the needs of the school-aged population to
addressing lifelong aquatics participation. a
Carter, Dolan, and LeConey (1994) have recog-
nized that individuals with disabilities possess differ-
ent levels of aquatic skills and that a continuum based
on participant skill (with inclusion as the ultimate
goal) is the model that best addresses an individual’s
assessed needs. “This approach recognized that
specific participation outcomes are influenced by
participant functioning capacity, and that the degree
of staff intervention is dependent upon participant
functioning level” (Carter et al., 1994, p. 4). Level I
includes services for individuals needing prerequisite
skills, such as increased range of motion, balance,
and tolerance of frustration, and for individuals with
fragile health needs. The student-to-teacher ratio is
low, as low as one to one, and once a participant
has acquired basic safety and aquatic skills, he
moves to level II. Level II is where individuals learn
adapted aquatic skills and other skills that they need
to participate in aquatic activities, including self-care
in the locker and pool b
area. Levels I and II are
generally segregated,
serving only partici-
pants with disabilities.
Participants in level
III receive additional
experience needed to
function in an inte-
grated setting. Reverse
inclusion might occur,
and the instructor helps
the participant general-
ize the skills learned in
levels I and II to group
settings. Level IV is
called LINK (the leisure c
integration network)
and involves inclusion Figure 3.4  (a) In phase 1 of the continuum of aquatics integration, participants work in a
segregated setting to acquire basic swim skills. (b) In phase 3 of the continuum of aquat-
with resource support. ics integration, participants practice skills in a reverse inclusion setting. (c) In phase 7 of the
The support comes continuum of aquatics integration, participants use the skills acquired through the continuum
from advocates for during a free swim.

individuals with disabilities and staff members who
act as resources in the community or facility.
While more dated than the Carter, Dolan, and
LeConey model, the Canadian Red Cross (1989)
model provides adapted aquatics instructors with
more information on implementing a continuum of
aquatics integration. Originally created by Lister-
Piercy (1985), this model has seven phases. In phase
1, participants acquire basic aquatic skills in a seg-
regated environment in small groups or one on one
(see figure 3.4a). These skills include entry, exit, water
orientation, and propulsion. Once these skills are
mastered, the swimmer moves into phase 2, where
she works on generalizing her skills with different
instructors and even in various facilities. Phase 3
involves reverse inclusion with select participants
without disabilities (see figure 3.4b). Phase 4 expands
the instructional environment to include friends and
family in integrated recreational activities. Phase 5 is
an inclusion setting with maximum assistance. The
instructor who has been with the participant from
the beginning provides physical and learning sup-
port within the general aquatic setting. In phase 6,
the instructor eliminates some of the support within
the included setting by staying out of the water while
still maintaining verbal and visual support. The final
phase, phase 7, eliminates the adapted aquatics
instructor from the pool area, and the person is now
self-sufficient in the general aquatics class, program,
or free swim (see figure 3.4c). Some individuals may
progress through the entire continuum; some may
start and finish at various stages along the way. Some
participants may stay where they start or not move
much higher up the continuum. Whatever happens,
the participant, caregivers, and aquatics personnel
must be flexible, moving up or down the continuum
as needed.
Recommendations and Concerns
The LRE flowchart by Eichstaedt and Lavay (1992)
and the continuum by the Canadian Red Cross and
Lister-Piercy serve as models for aquatics programs in
the quest to provide a continuum of placements that
ensures quality instruction for individuals with dis-
abilities in school- and community-based programs.
Another helpful resource for integration is presented
in Johannsen (1987), and an adapted physical educa-
tion model is found in Sherrill (2004).
However, the continuum of alternate placements
has been challenged as a violation of civil rights, as a
method of reinforcing a dual system of education (spe-
cial education versus general education), and as a way
to continue denying individuals with disabilities their
rightful place in mainstream society. For example,
Inclusion and the Least-Restrictive Environment 47
some individuals within the continuum never achieve
the skills necessary to move into an inclusion aquat-
ics class, if we view the required skills as being the
physical, cognitive, or behavioral skills demonstrated
by same-aged peers without disabilities. The idea that
some individuals will never progress to the next level
and thus will always be segregated is what human
rights groups oppose. If we look at the continuum
in this manner, how could we possibly support this
segregation? What we support is placement in a group
with similarly aged peers in which an individual with
a disability has an emotionally and physically safe
environment, is able to reach the class goals or their
own IEP goals, and can participate to the maximum
extent possible in the general aquatics program.
Although we see a continuum of placements as
affording options and reasonable accommodations,
it has its issues. Many people have concerns about
its often segregated settings. Many facilities do not
offer enough placement options to their members,
so that placement on the continuum becomes either
inclusive or segregated. Individuals with severe dis-
abilities may never acquire the necessary skills to join
integrated programs because they lack the prerequi-
site skills. Only through informed parents, caregivers,
consumers, adapted aquatics instructors, and general
aquatics instructors may the adapted aquatics profes-
sion even begin to bring clarity to this issue.
Prerequisites to Successful
Inclusion
Simply combining people with and without dis-
abilities does not necessarily lead to inclusive experi-
ences; there must be a method of creating inclusion.
“Creating inclusion involves elimination of internal
and external constraints in all areas of the aquatic
environment” (Devine & Broach, 1998, p. 61).
Removing constraints begins with examining three
areas: administrative policy, physical accessibility,
and, most importantly, attitude.
Administrative details include but are not limited
to program and class advertisement and registra-
tion, procedures for requesting accommodations,
confidentiality, privacy, financial constraints, staff
qualifications and training, program limitations, and
position statements on inclusion and accessibility.
Physical accessibility relates to all aspects of the facil-
ity, from the parking lot to the lobby to the dressing
rooms to the pool deck to the pool itself. Eliminating
negative attitudes by administration, staff, instructors,
and pool patrons is vitally important to the success of
inclusion in aquatics. The issues surrounding attitude
48 Adapted Aquatics Programming
include stereotyping, lack of acceptance in inclusive
programs, lowered expectations, and lack of under-
standing of physical or behavioral characteristics. To
create an inclusive environment, several prerequisites
must be in place in the administrative policies, the
physical accessibility of the facility, and the attitude
emitted by administration, staff, and pool patrons. In
general, prerequisites for creating inclusion involve
the participant, environment, and program.
Participant Prerequisites
As discussed previously, people who support a contin-
uum of placements (Federal Register, 2006) recognize
that a participant with a disability might learn best in
an alternative placement rather than a general class.
Since many aquatics instructors teach in curriculum-
based progressive swim programs (such as those of
the ARC or YMCA) that rely on participants passing a
class before moving to the next level, aquatics instruc-
tors generally agree that an individual must meet
certain prerequisites before safely and successfully
moving up a level. When peers without disabilities
are able to successfully master a swim level while a
swimmer with a severe disability cannot, it is not in
the student’s best interest to socially promote him
in order to help him stay included. To successfully
learn swimming skills in inclusive aquatic settings,
swimmers with disabilities, their instructors, and the
aquatics program in general must meet basic prereq-
uisites. Participants should have a minimum level of
competence and meet minimum health and behavior
criteria as prerequisites to joining inclusive aquatics
classes. Participant prerequisites include medical and
health considerations as well as the social, behav-
ioral, cognitive, and aquatic readiness that are vital
to inclusive group integrity and learning.
Unfortunately for some parents, caregivers, and
swimmers with disabilities, consideration of behav-
ioral, cognitive, and medical and health conditions
sometimes serves as a means of discrimination and
exclusion, when in reality it should form the foun-
dation of making safe accommodations in a class or
program. Program providers should avoid making
general judgments and statements about a disability
regardless of their experience with individuals with
similar disabilities; such generalizations are stereo-
typical and therefore against the intent of all civil
rights legislation. Moreover, generalizations often
lead to false assumptions about an individual’s abili-
ties, resulting in loss of credibility, strained relation-
ships, and wasted instructional time. You must assess
each individual on a case-by-case basis to determine
whether health conditions require an alternative to
the general setting, support from an adapted aquat-
ics specialist, a smaller group size, peer or volunteer
assistance, health care provider assistance, or no
assistance.
The sidebar on included settings on page 49 lists
several examples to help you handle the issue of
prerequisites and provide the best placement for each
individual with disabilities that you serve. Examine
these examples, which address health or safety con-
cerns that may hinder performance in a general setting
or interrupt the general group on a continual basis so
that learning is hindered for others. Each situation is a
scenario that might force the professionals and family
involved to discuss a more restrictive placement for
aquatics participation.
Health and medical reasons are but one set of
concerns that may preclude inclusion in general
aquatics classes. Other issues that might require
support outside of general aquatics include those of
safety, physical comfort, behavior and cognitive skill
deficits, and emotional maturity. However, as with
medical conditions, never assume that participants
with behavior or cognitive deficits automatically need
emotional or learning support or that either the gen-
eral or alternative class setting is the most appropriate.
Instead, as you seek to match the participant to the
best setting, discuss the behaviors that the participant
exhibits with your team members, including the
parents, and you may uncover valuable information
that will help your placement. Some individuals, for
example, have fewer behavioral outbursts when with
an instructor of a particular gender, voice modulation,
height, weight, race, ethnicity, or the like. Although
the goal is to have participants respond appropriately
to anyone, you may need to adjust your thoughts and
actions to initially accommodate an individual and
then gradually bring in others to help the participant
get used to a variety of people within the aquatic
environment.
Although age-appropriate groups are desirable,
participants with severe cognitive disabilities may
not reach their full potential when included with
same-aged peers due to problems with receptive or
expressive language and the complexity of direc-
tions and tasks. Some professionals believe that if an
individual with a severe disability has the appropriate
learning support (such as an adapted aquatics instruc-
tor, assistant, or additional general instructor), he can
work on tasks similar but not identical to the tasks
the group is doing. Unlike in land-based physical
activities, sometimes an individual with a disability
cannot participate in the same aquatic activities with
same-aged peers due to lack of ability. For example, if
the entire instructional unit takes place in the diving

Included Settings
The following health and medical situations
warrant discussion about whether inclusion is
the best placement:
❚ Individuals with detached retinas who
need to avoid projectiles, such as balls,
and any bumping of the head and
face
❚ Individuals who experience a large
number of seizures that lead to emer-
gency removal from the pool and that
cause clearing of the pool due to medi-
cal emergency
❚ Individuals who have tracheotomy tubes
or are ventilator dependent and thus
require shallow water, qualified health
care professionals, heavily grounded
electrical cords, and calm water with
no splashing
❚ Individuals with certain neuromuscular
conditions who require a certain water
temperature that may not be available
in the general aquatics facility
❚ Individuals with certain neurologi-
cal conditions who require a gradual
change from water to air temperature
due to inadequate thermoregulation
systems
❚ Individuals with a high susceptibility to
infection who need more sterile environ-
ments, such as those who are allowed
no close contact with individuals outside
their families
❚ Individuals with allergies to chlorine
who thus require pools with alternative
chemicals
❚ Individuals with behavior disorders,
whether noncompliant behaviors or
uncontrolled aggression, who compro-
mise the safety of others
❚ Individuals with hemophilia who require
calm water, limited bumping into other
participants and equipment, and modi-
fied pool temperatures due to arthritic
conditions
❚ Individuals with open sores, such as
decubitus ulcers, who are generally
prohibited from swimming in a public
pool
Inclusion and the Least-Restrictive Environment 49
well and the individual is overly fearful of deep water
or cannot be adequately secured and comfortable in
a flotation device, she cannot participate in the diving
well. Alternatives to diving might include working
on fitness swims with an instructor aide, temporarily
joining a segregated program, or working with an
adapted aquatics instructor in the shallow end while
others dive. Such an approach is only acceptable if
the support person is trained in adapted aquatics.
Why should the individual with the greatest needs
be taught by an assistant or paraeducator while the
others work with a trained aquatics instructor? Even
so, look for one or two activities that the person can
participate in with same-aged peers.
Individuals who will be included in general aquat-
ics classes need to have behavioral characteristics
that respond to principles of applied behavioral
analysis and do not compromise the entire group’s
integrity. Students who bite, pinch, kick, scream,
throw objects, or yell inappropriate statements may
have a better chance of being successfully included if
those behaviors are first addressed in a smaller group
or one-on-one setting rather than in a large, general
aquatics class. When individuals with disabilities pose
a safety threat to the instructor, other aquatics patrons,
or themselves, even when reasonable accommoda-
tions have been provided, an aquatics program can
legally deny participation.
A program cannot establish rules for course
entrance that exclude individuals with disabilities;
“however, rules can be established which are neces-
sary for the safety or health of participants, which
happen to screen out some individuals with disabili-
ties” (Osinski, 1993, p. 14). For example, a policy
that prohibits individuals with behavior disorders
from participating in a specific aquatics program is
illegal, but a policy that prohibits individuals who
bite others may be acceptable. You should seek legal
advice for your particular situation from your super-
visor and possibly from the organization or school
district attorney.
Aquatic skill prerequisites may be necessary for
success in some aquatics classes, especially if there
is no additional personnel support. Even simple tasks
such as holding the pool gutter, closing the mouth
when someone splashes, or not drinking pool water
might be necessary for success in the general class
(see figure 3.5).
This is not to say that a person who cannot perform
these skills should not be included. However, certain
skills might be necessary for successful inclusion,
especially if no additional help or equipment is pro-
vided. With proper support, you can be flexible and
include individuals who may not be able to achieve
 50 Adapted Aquatics Programming
Photo courtesy of Shawn Stevens
Figure 3.5  Some swimmers need to be taught prerequisite skills such as grasping the
pool wall.
the prerequisites but are good candidates for alter-
native or parallel skill acquisition within a general
aquatics group. In short, while you should carefully
consider aquatic skill prerequisites when matching a
participant and setting, a failure to meet some of the
prerequisites should not be the only reason to suggest
an alternative placement.
Environmental Prerequisites
Each aquatic setting brings with it environmental
conditions that either support or negate the inclusion
of individuals with disabilities. To set up the most
effective environment for inclusive groups, you must
view each participant as an individual and provide
some general environmental conditions that support
inclusive, successful settings. The environment is
made up of both physical distinctions and learning
characteristics. Physical distinctions include pool and
air temperatures, drafts, lighting, acoustics, pH and
chemical makeup of the water, coloring, equipment
in the area, and accessibility features. The prerequi-
sites that are needed in the physical environment are
unique to each person, but you can make an appropri-
ate match between participant and environment when
you consider questions such as the following:
• Does the target setting match the individual’s
needs? For example, does the participant work
better with a pool temperature greater than
or less than 85 °F (29.4 °C)? Is the participant
comfortable in a large open space, or does she
require a smaller, more contained setting?
• For health reasons, does the
participant have to be cautious
about moving from one temper-
ature extreme to another? For
example, in the target setting do
the air and water temperatures
differ by more than 4 or 5 °F
(2.2-2.8 °C)?
• Does the pool deck have ade-
quate storage space for wheel-
chairs, crutches, walkers, or
canes? Does this affect safe
accessibility?
• Is the individual allergic to
chlorine or bromine?
• Does the participant have diffi-
culty maintaining attention? For
example, are there too many
people in the area, possibly
distracting the participant?
• Are there materials in the area
that may be an attractive nuisance to an impul-
sive or a noncompliant participant?
• Do the pool acoustics encourage yelling by
people who like to hear echoes?
• Does the participant have intense medical or
health needs? Is the environment physically
safe for the individual?
Consideration of the physical environment gener-
ally comes last in the minds of parents, participants,
and caregivers. But issues including facility location,
architectural accessibility, and air and water tem-
peratures are important when selecting an adapted
aquatics program.
Even more crucial for most participants is the
learning. A caring instructor who is educated about
aquatic activity modifications and contraindications,
cross-disciplinary techniques and communication,
and ethical treatment of individuals with disabilities
and who has the skills to individualize aquatics pro-
grams is more important than space or equipment.
Use the following questions to help you evaluate the
learning environment:
• Do instructors treat individuals with disabilities
with dignity and respect?
• Do instructors present activities in an age-
appropriate manner?
• Are task progressions flexible enough to
accommodate individuals who may not have
the ability to perform parts of the progression?
For example, is the task progression for a swim

stroke flexible enough to allow a swimmer
who has a lower limb amputated to progress
even when he cannot accomplish the kick to
a stroke?
• Do instructors use a variety of teaching meth-
ods?
• Do individuals with disabilities receive oppor-
tunities to respond to task requests?
• Do instructors accept differences in perfor-
mance?
• Is cooperation rather than competition the main
thrust of the class?
• Do individuals with disabilities feel emotionally
safe enough to try the skills presented?
• Have other participants in the class been edu-
cated about inclusion and aspects of ability,
diversity, and acceptance of differences?
As important as the prerequisites for the learning
environment are, they may be greatly influenced
by the third category of prerequisites: program pre-
requisites.
Program Prerequisites
Program prerequisites are considerations for successful
inclusion that are made throughout a program and not
just in one class. These components are administrative
and trickle down to every program that is conducted
(i.e., not just adaptations in the 3:00 P.M. swim class,
but all learn-to-swim lessons). They include but are
not limited to the following suggestions:
• Program and instructional goals and objectives
are clearly stated. Adaptations cannot be made
unless you have basic objectives.
• Staff members, including locker-room work-
ers, desk clerks, instructors, and lifeguards, are
educated about disability differences. Before
initiating an inclusion program, education is
provided to identify and improve attitudes,
skills, and knowledge.
• Before the program begins, other participants
in the program and patrons in the facility are
educated on acceptance of diversity and facts
about various disabilities. This education can be
done with a community meeting at the facility
or with a flyer describing inclusion.
• Formal assessment and discussion with partici-
pants and significant others provide for place-
ment decisions, and assessment results provide
the basis for how to individualize programs.
• Prerequisites to entering a class are flexible.
You often must match age, ability, and social
Inclusion and the Least-Restrictive Environment 51
skills to a nontraditional class placement. For
example, the prerequisite for getting into a
learn-to-swim program may be the ability to
stand on the bottom of the pool with the face
above water. A program must be flexible enough
to reasonably accommodate an individual with
dwarfism even though she may not meet the
height requirement.
• The administration is flexible about allowing
individuals to move from one class to another
in order to meet their needs.
• Facilitators of the program communicate with
the participant in his desired mode or accom-
modate an interpreter or the use of alternate
formats.
• The program offers proper support in and
around the pool or allows parents, caregivers,
or aides to be in and around the pool at no
additional cost.
• Administrators highly respect and encourage
collaboration among instructors, therapists,
parents, caregivers, and participants.
• Instructors place participants with disabilities
into the general aquatics program in naturally
occurring proportions, which suggests a maxi-
mum of 10% to 15% of individuals with dis-
abilities in a class.
• Participants who need help outside the regular
aquatics program receive that help in order to
achieve more.
Devine and Broach (1998) developed several sug-
gestions for maintaining inclusion in a program. First,
all administration, staff, and instructors “must treat
inclusion as a priority in the delivery of services” (p.
65). The organization and facility must have inclu-
sion as part of the mission statement and goals and
must reflect this by offering a variety of participation
options for people with disabilities. The staff must
provide ongoing evaluation and updates to these
programs to allow for improvements and growth.
Flyers and other advertisements should be made
available in alternate formats, and it should not be
a hassle to have these provided. Staff members must
have sensitivity training that includes skills in using
language that puts individuals first, making accom-
modations, and developing methods to make people
with a variety of needs feel comfortable.
The tenets of successful inclusion are that the par-
ticipants have the prerequisite skills for safe and suc-
cessful participation, that the physical and learning
environments match the needs of the participants, and
that the program has the flexibility to accommodate
a variety of abilities and learning styles.
52 Adapted Aquatics Programming
Developing and Maintaining
Successful Inclusion Groups
In the remainder of this chapter, we’ll focus on the
practices that develop and maintain high-quality
inclusive aquatics groups. The purpose of inclu-
sion in aquatics classes is to provide opportunities
for all people to learn and recreate together—to
interact as they do in the rest of society. Benefits of
inclusion include an opportunity to learn in natural
environments with age-appropriate role models, a
greater potential for friendships and social contacts,
a decrease in isolation, an increase in expectations
and challenges, and an opportunity to change the
attitudes of swimmers without disabilities toward
being more accepting of differences (DePauw, 2000).
Another benefit is that inclusion meets the spirit of
the ADA and IDEA.
Earlier in the chapter we discussed some pre-
requisites for inclusion. Specific considerations for
developing and maintaining successful inclusion
groups center on instructor preparation; learning
and physical support needs (see figure 3.6); age of
group members, group makeup, and group size; and
framework for task presentation. In the following
sections, we’ll look more closely at the challenges
of and strategies for providing an environment that
fosters inclusion in aquatics groups.
Figure 3.6  Inclusive aquatics classes often need additional adult help.
Instructor Preparation for Teaching
Inclusion Groups
Not surprisingly, experts agree that a key factor to suc-
cessful inclusion is the instructor (Block & Conatser,
2002; Reid, 1979; Weiss & Karper, 1980). An aquatics
instructor’s beliefs and knowledge about swimmers
with disabilities, available resources (such as equip-
ment), and quality hands-on training are the three
most important factors that affect successful aquatics
inclusion (Conatser & Block, 2001; Conatser, Block,
& Lepore, 2000). Insufficient training of the staff and
inadequate education and experience of the instruc-
tors are major reasons why inclusive aquatics pro-
grams fail (Priest, 1979). In general, special education
programs across the United States have addressed the
quality and consistency of teacher training, and there
are new national mandates for highly qualified special
education teachers (U.S. Department of Education,
2005). Hopefully, this thrust to have highly qualified
personnel will induce a trickle-down effect, making
all programs that serve people with disabilities call
for more professionals who are highly qualified by
national credentialing. Naturally, poor instructor
preparation negatively affects the success of the
program. In a study of physical educators’ reflections
on preparation for inclusion, Brent Hardin (2005)
found that hands-on teaching is the most valuable
knowledge source for learning how to teach physical
activity classes to students with disabilities. Ranking
closely behind hands-on experience
are the examples and resources of other
teachers and course work in adapted
physical education. This study can be
generalized to adapted aquatics and
compared to the studies by Conatser
in conjunction with Block and Lepore
(Conatser & Block, 2001; Conatser et
al., 2000), which suggest that knowl-
edge, attitude, hands-on training, and
resources are valuable. What, then, do
adapted aquatics instructors currently
in the field need? They need stronger
training opportunities that stress inclu-
sive practices, several levels of training,
hands-on mentoring opportunities with
master teachers, and dissemination of
information about resource availability.
The following section of this chapter
focuses on training opportunities that
exist on three levels: (1) formal certifi-
cation and credentialing (preservice),
(2) conferences and seminars, and (3)
in-house training (in-service).

Formal Certification and Credentialing
Formal certification and credentialing of adapted
aquatics instructors in the United States consists of
attending a course given by one of two organiza-
tions providing specialty certificates for instructional
aquatics programs. AAPAR (formerly AAALF) of
AAHPERD and also the YMCA offer a course for
teaching swimming to individuals with disabilities.
Successful completion earns credentialing or certifi-
cation for working with individuals with disabilities
in aquatics. The YMCA course requires current certi-
fication as a YMCA swimming instructor and consists
of approximately 12 hours of lecture and practical
water work. The AAPAR course requires any approved
national aquatics instructor credential (such as the
YMCA or ARC Water Safety Instructor certification)
and consists of 24 hours of lecture, discussion, and
practical work. Both courses use this book as the text,
and both have been updated and repackaged since
2002. Other programs offered through AAPAR are the
adapted aquatics assistant, which is for those who do
not have the prerequisite swim instructor certification,
and the adapted aquatics adjunct, which is for those
who do not have the prerequisite swim instructor
certification but possess the skill, knowledge, and
attitude for co-conducting integrated or segregated
aquatics programs with water safety or aquatics
instructors. To be eligible for this credential, a person
must possess an advanced degree in APE, special
education, therapeutic recreation, physical or occu-
pational therapy, or general physical education.
There are wonderful upsides to credentials and certi-
fications. There are also some downsides to the current
programs. One upside is that the master teachers and
instructor trainers in the programs are dedicated to
making the swimming world accessible to people with
disabilities. The information provided in the programs is
updated and professionally packaged. And the programs
are still going on! A downside to the current national
programs is that both are seldom offered and both are
advertised little outside of the current members of each
organization. Both programs do not have enough infor-
mation on inclusive aquatics, and both provide little to
no hands-on experience with inclusive aquatics. The
YMCA program is quite short, and the AAPAR program
is virtually unknown except in physical education
circles. The fact is that not enough information is given
in credential programs on inclusive teaching. There is a
need for a basic course on disability issues and a more
advanced course on inclusion in adapted aquatics. With
its recent update, the AAPAR program now includes
much more information on inclusive teaching and tips
for inclusion on its course CD-ROM for the master
teacher. This update is a good first step toward formal
Inclusion and the Least-Restrictive Environment 53
certification and credentialing that meet the needs for
developing and maintaining inclusion groups.
Conferences and Seminars
Conferences and seminars provide up-to-date,
accurate information about practical techniques
and theoretical concepts as well as offering a forum
for new or controversial issues. Experts can present
their research on aquatics, exercise, swimming, and
individuals with disabilities in a short amount of time
and are easily accessible for questioning.
Unfortunately, however, aquatics instructors with
an interest but no formal experience in disability
issues often feel overwhelmed at conferences and
seminars due to their lack of background knowl-
edge or understanding of specialized professional
jargon. Small seminars at which the facilitator asks
about everyone’s background may demonstrate more
sensitivity to the novice than large conferences dem-
onstrate. Another concern with attending national or
regional conferences is that they tend to be far away,
and travel funds are usually limited for community,
recreational, or educational professionals. Some pro-
fessionals, however, participate in conferences as a
means of earning continuing education units (CEUs),
which they apply to certification requirements in
their respective health care professions. In addition,
such travel expenses and conference fees are prob-
ably tax deductible for you as an individual; check
the current tax code. Aquatics instructors who want
to increase their knowledge about adapted aquatics
and individuals with disabilities attend conferences
such as the AAHPERD National Convention (www.
aahperd.org), the Aquatic Therapy and Rehabilitation
Institute Specialty Institutes and Symposiums (www.
atri.org), the World Congress and Expo on Disabili-
ties (www.wcdexpo.com); the USWFA conferences
(www.uswfa.com), the National Center on Acces-
sibility courses (www.ncaonline.org), the American
Therapeutic Recreation Association conferences
(www.atra-tr.org), the World Waterpark Association
symposium and trade show (www.waterparks.org),
the National Swimming Pool Foundation World
Aquatic Health Conference (www.nspf.org), the
National Recreation and Park Association National
Aquatic Conference and Exposition (www.nrpa.
org/nac), the IDEA Health and Fitness Association
World Fitness Convention (www.ideafit.com), and
the National Intramural-Recreation Sports Association
Aquatic Institute (www.nirsa.org/education/aquatic).
Other opportunities for conference attendance can be
gleaned from the Web sites for the National Center on
Physical Activity and Disability (www.ncpad.org) and
for Aquatics International (www.aquaticsintl.com).
54 Adapted Aquatics Programming
In-Service Programs
A third method of education in adapted aquatics is a
site-based in-service program. In this setting an expert
who is on staff or from an outside agency comes to a
facility to train the personnel. Such training is usually
low cost, and generally only the presenter travels. The
expert can tailor presentations to the specific staff,
facility, and population served, and it takes minimal
effort to organize the training. The expert might pres-
ent safety concepts related to individuals with balance
problems, motor control problems, or sensory input
problems; transfers between wheelchairs and pools;
positioning; and various emergency situations such
as seizures, asthma episodes, and diabetic incidents.
In addition, the expert can cover issues related to
identifying and changing attitudes and task and
activity analyses as well as offering tips for inclusion
and for adapting stroke propulsion and water safety
skills. In-service education also facilitates informal
brainstorming and professional case study discus-
sions of clientele. One organizational pattern used
for in-service education is the working group. In this
scenario, the group has one or more problems that
need to be solved. The outside expert helps to focus
the problem and to generate solutions. Thus the in-
service education directly relates to the organization
or facility. A disadvantage of in-service training is that
the attending instructors may focus on their specific
problems and ignore the broader issues. In-service
training is usually mandated, which tends to restrict
the enthusiasm of the group and result in a lot of
coping behavior.
Supports for Inclusion Groups
Another critical factor in developing successful
inclusion programs is resource, moral, technical, or
evaluation support.
• Resource support comes from things such as
adaptive equipment, financial resources, infor-
mation resources, and human resources.
• Technical support can come from a consultant
who provides strategies, adaptations, in-service
education, and team teaching or collabora-
tion.
• Evaluation support includes an adapted aquat-
ics instructor helping the general aquatics
instructors with assessments, the determination
of support services, and the monitoring of goals
and objectives.
• Moral support includes experienced instructors
providing examples for and assisting (perhaps
mentoring) the general aquatics instructor
(Block, 2000).
A program may have all of the support that is
mentioned here and still not be able to provide the
required safe, successful, and meaningful learning
experience within the fully inclusive instructional
setting. Keep in mind that a few participants do not
fully benefit from an inclusive instructional setting,
no matter how much support you provide.
Resource Support
In their research, Conatser and Block (2001) demon-
strated that getting resource support is one of the top
three challenges to successful inclusion. Instructors
must have adequate equipment, up-to-date informa-
tion, and trained personnel. They need a variety of
equipment, such as flotation devices, so that they
may try different combinations of support for their
swimmers. Creative toys dramatically enhance the
ability of the aquatics instructor to actively engage
a swimmer with various attention, flotation, and
propulsion needs. Instructors also need the financial
resources to purchase and maintain their equipment
supplies. Adapted flotation devices, like the ones in
figure 3.7, can physically support a swimmer who has
not been successful in independent swimming. Due
to the expenses for construction, extensive research,
and design experimentation, specialized flotation
devices may be 4 to 5 times the cost of typical devices.
The trade-off is an individual who can now become
independent, fit, and healthy! See www.pfd-a.com
for personal-flotation-device-adapted (PFD-A) jackets
and www.danmarproducts.com for specialized swim
aids designed for people with disabilities.
Another aspect of resource support is informa-
tion resources. Knowing where to look for new and
creative flotation devices, current teaching strategies,
safety tips, and general updates in the aquatics field is
critical. Many Internet resources are available, includ-
ing PE Central (www.pecentral.org), PELINKS4U
(www.pelinks4u.org), and Project Inspire (www.
twu.edu/inspire). On their Web sites, PE Central and
PELINKS4U have dedicated pages to APE and explain
adaptations to typical land-based activities that can
easily be used in the pool. Project Inspire is the most
informative Web site for APE and has more informa-
tion on adapted aquatics than most other Internet
sites have. The section on various disabilities and
adaptations for aquatics is superb, as are the sections
on assessment tools, other aquatic activities (such as
swimming in the Special Olympics), dolphin therapy,
and adapted scuba.
There are also many information resources avail-
able in the written world. Some journals that fre-
quently publish articles related to adapted aquatics
include the Journal of Health, Physical Education,
Recreation and Dance; Palaestra; and Adapted Physi-

Figure 3.7  From foam noodles (left) to the WetVest (middle) and PFD-adapted jackets (PFD-A) (right), flotation devices
can facilitate independent mobility.
cal Activity Quarterly. Books that have quality infor-
mation about adapted aquatics are Adapted Physical
Activity, Recreation, and Sport: Crossdisciplinary and
Lifespan (Sherrill, 2004), Adapted Physical Education
and Sport (Winnick, 2005), and A Teacher’s Guide
to Including Students With Disabilities in General
Physical Education (Block, 2000).
In addition, the following other information
resources have proven helpful: the National Center
on Physical Activity and Disability (www.ncpad.org);
the American Alliance for Health, Physical Education,
Recreation and Dance (www.aahperd.org); the Aquatic
Resources Network (www.aquaticnet.com); the Grosse
Adapted Aquatics Database (http://goliath.ecnext.
com/coms2/gi_0199-121173/Grosse-S-J-2002-Grosse.
html); and the Adapted Aquatics Web site (www.
adaptedaquatics.org).
The final aspect of resource support, human
resources, is critical. In addition to qualified instruc-
tors, a trained person who provides physical or
learning support is invaluable. Examples of human
resources include adapted aquatics adjuncts or assis-
tants, paraeducators, peer tutors, coinstructors, and
parental volunteers. Having an extra adult available
to physically help individuals who cannot hold the
wall, maintain head control, stand in the pool, or
close their mouths to prevent swallowing water is
Inclusion and the Least-Restrictive Environment 55
crucial to safety and success. You should evaluate
what human resources participants will need before
the classes begin rather than automatically assuming
what is needed.
Adapted aquatics assistants, paraeducators,
and peer tutors can also provide learning support.
Learning support (use of any device, technique, or
individualized instruction) provided in addition to the
general program aids learning and is a positive aspect
of support within the inclusive setting. The expertise of
all personnel, including volunteers, special education
teachers, interpreters, adapted aquatics instructors
and assistants, parents, and related service personnel,
may serve as vital learning support. Participants who
spend part of the time with the general aquatics class
and the remaining time working one on one with
their aquatic learning support person demonstrate
one method of using learning support.
Often underutilized, paraeducators who work with
school students who have disabilities and come with
students to the swimming pool during the school
day are welcome additions to the aquatics support
staff, if well trained. In the APE literature, there are
three superb references on paraeducators: “Utilizing
Paraprofessionals in the General Physical Education
Setting” by Horton (2001); “Paraeducators in Physical
Education” by Cindy Piletic, Ronald Davis, and Amy
56 Adapted Aquatics Programming
Aschemeier (2005); and Paraeducators in Physical
Education: A Training Guide to Roles and Responsi-
bilities (Lieberman, 2007).
One additional human resource that can help
develop and maintain learning in inclusion groups is
the peer tutor. A peer tutor can be a same-aged peer
in the class or can be a few years older. Peer tutors
must be trained through in-service, which can include
the ARC’s Water Safety Aide training as well as the
AAPAR’s Adapted Aquatics Assistant training.
In an inclusive setting, learning support is typi-
cally given during the entire aquatics experience.
While this support can be provided by a variety of
individuals trained to meet the needs of the par-
ticipant, an adapted aquatics instructor is the most
competent and qualified choice to provide learning
support for individuals with intense needs. She can
individualize and interpret instructions, adapt the task
so it is within reach of the participant, or carry out
instructions related to goals from the individualized
aquatics program plan. Other learning supports such
as special educators or parents may be appropriate
for participants who require continuous structure and
consistent behavior management.
Technical and Evaluation Support
Although the adapted aquatics instructor was just
considered human resource support, Block appropri-
ately titles the consultation provided by the adapted
aquatics instructor as technical support. The adapted
aquatics specialist might serve in the consulting role
to facilitate inclusion, provide hands-on support
during the inclusive lesson as needed, and act as
the in-service educator on inclusion, accessibility,
assessment, and modifications. Another role for the
adapted aquatics specialist is to provide evaluation
support. The adapted aquatics instructor provides
assessment and evaluation support; collaborates with
the family, swimmer, and general aquatics instructor
for placement decisions; and monitors the goals and
objectives that are targeted for the swimmer.
Moral Support
Moral support for aquatics instructors should not
be downplayed. Aquatics instructors who embrace
inclusion will have days when they feel that they have
failed! Having adapted aquatics colleagues who can
sympathize, energize, and reflect with them can be
the edge between never wanting to teach inclusive
aquatics again and moving forward with other ideas
and energy. Mentors, colleagues, and coworkers who
can contemplate the concerns and anxieties of the
general aquatics instructor who has just struggled with
an inclusive lesson will help encourage the instructor
to be positive and forge on. Aquatics instructors learn
a lot from each other by observing, co-teaching, and
discussing what works and what does not.
Group Dynamics in
Inclusion Groups
To fully embrace the general philosophy of inclusion,
programs should provide individuals with disabilities
the opportunity to participate in age-appropriate
activities with peers of similar ages. Age appro-
priateness also includes gearing tasks, activities,
peer interactions, and materials to a participant’s
chronological rather than functional age. When
developing activities, aquatics instructors must plan
age-appropriate music, names of activities, and
equipment that peers without disabilities would use.
These considerations help create an age-appropriate
aquatic experience.
Age Considerations
A complicated task when planning for successful
inclusion is balancing chronological age groupings
with the developmental level of a swimmer who is not
at the physical, social, cognitive, or emotional age of
her peers. Chronological age groupings and skills that
are needed to function in the community are neces-
sary components of an inclusive aquatics program.
Individuals must participate similarly to same-aged
peers although the activities, directions, and tasks
may be modified for developmental appropriateness.
However, some students who are not on the same
cognitive, physical, and social developmental level as
their same-aged peers are more successful when they
are included with peers that are 1 to 2 years younger.
Since swim groups in community programs are not
usually homogeneous in age (except for preschool
lessons), form groups with an age range that spans no
more than 3 years. Also, you should organize younger
participants in groups with narrower age spans due to
the tremendous differences in growth and develop-
ment that occur during the younger years.
If the swimmer with a disability is at the high end
of the age span, and you are doing activities that
seem babyish for that chronological age, modify
them to be more age appropriate as defined by the
participant’s age and the environment in which the
individual must function. For example, 18-year-old
men and women do not “glide like Superman,” “bob
like rocket ships,” or “dive for Big Bird tokens,” but
they might glide off the wall for as long as they can
after a flip turn, have a cannonball jumping splash
fest, or play inner tube basketball.
The easiest way to determine what is age appro-
priate is to integrate individuals with disabilities into
same-aged peer groups. Ask the participants to do

what they wish for 10 minutes and observe. Typically,
adults will walk or jog in the water, use a kickboard,
stretch, swim laps, dive, or tread water. Teenagers
might sit in tubes, throw a ball around, swim under-
water, try to sit and surf on kickboards, dive, jump,
or swim laps. Elementary school students will have
underwater contests, toss and pick up rings and coins
from the pool bottom, lie on kickboards, paddle in
tubes or rafts, splash and spit water at each other,
and repeatedly jump into the pool. Young children
who can stand in the pool will practice the doggie
paddle, do underwater twists and turns, attempt to
sit on and touch the pool bottom, try to open their
eyes underwater, throw balls, float in tubes shaped
like animals, kick their feet, jump up and down, and
attempt to jump into the pool many times. Infants and
toddlers, when held or sitting in shallow water, will
splash themselves, play and reach for toys, suck and
bite equipment, and try to drink the pool water. While
not all individuals will exhibit these behaviors, they
are fairly typical behaviors of each age group.
Although many individuals with disabilities may
not have the prerequisites to engage in common age-
appropriate activities, you must make some informed
decisions, such as when to modify an activity for a
participant who may never have the prerequisites for
the unmodified version. For example, even when the
participant has not mastered grasping a ball in order
to fully play inner-tube water polo, if possible go
ahead and modify the activity to let the participant
play anyway (maybe with full physical assistance).
The participant may work on ball grasping during
the actual game by holding a ball for the entire
time the team is on offense or by throwing the ball
inbounds after each score. Keep in mind that feeling
fully included, achieved by the aquatics instructor
modifying the activity to provide partial participation,
is a tremendous motivator.
Group Makeup and Size
Whether they have disabilities or not, individuals who
participate in aquatics classes often have diverse abili-
ties, interests, and motivation levels. Understanding
how each swimmer in the class learns and commu-
nicates helps you to plan for group makeup and size
(Sutherland & Hodge, 2001). Many aquatics programs
group individuals according to ability, giving some
consideration to age and instructor–pupil matching.
Instructor–pupil matching considers a participant’s pri-
mary mode of learning (visual, verbal, or kinesthetic)
and then matches the participant with an instructor
who teaches to that mode. Although not usually cru-
cial in general swim lessons, instructor–pupil match-
ing is a key dynamic in the makeup of inclusion groups
and can cause a class to succeed or fail.
Inclusion and the Least-Restrictive Environment 57
Inclusion Group Makeup
When making up inclusion groups, ability, age, and
instructor–pupil matching are the tangible compo-
nents that you can use to begin your formulation.
Patterns of aggressive and passive behaviors, personali-
ties, maturity levels, and social skill levels can also be
carefully considered in order to positively affect how
a group works together. Of course, inclusion groups,
with their diversity of physical, mental, and social
abilities, are a challenge in interpersonal dynamics.
The social development of each group member plays
an important role in the success of the group and there-
fore in how much each participant learns. Although
social interaction may be a secondary outcome of
swim lessons, individuals who cannot get along with
the teacher or other swimmers cause conflict within
the group and distract from learning. Yet diversity
does not have to preclude positive interactions. In
fact, diversity can enhance this aspect of the learn-
ing environment. As the instructor, you must take the
lead in developing an awareness of group dynamics,
teaching and enforcing the rules that govern effective
group behavior, and persistently trying to foster some
semblance of group cooperation.
No recipe can be written for balanced group
makeup. Individuals with disabilities are not a
homogeneous group with similar behaviors, so the
ingredients you must manage will change from class
to class. To develop cohesive group makeup, form
smaller groups (within the larger swim group) that are
homogeneous in ability, get to know the swimmers
by providing Get to Know You sheets at registration,
and collaborate with other professionals who know
the swimmer and know what might work in terms of
group makeup. It is suggested to include individuals
with disabilities in groups that have been prepared
for diversity and inclusion. Instructors should explain
diverse behaviors and learning styles to the group and
show a positive attitude toward including individuals
with disabilities. The instructor might say to the group,
“All individuals do not have the same abilities and
we need to be patient with everyone in the group.”
“Sam, who has Down syndrome, sometimes needs
me to help him while you are practicing.” “Loretta,
who has spina bifida, will need to wear shorts over
her suit because of a special device that helps her
stay healthy.”
Inclusion Group Size
Aquatics administrators and adapted aquatics advo-
cates are often asked, “What is the group size or
teacher-to-swimmer ratio for adapted aquatics or
inclusion groups?” Although the answer is not a
cut-and-dried one, there are a few guidelines we
can provide that will help you make some initial
58 Adapted Aquatics Programming
choices on group size. In a general aquatics class the
instructor-to-student ratio is typically 1 to 7, and the
ARC (2004b) recommends ratios between 1 to 6 and
1 to 10. A smaller class size is usually one of the
first group modifications recommended for teaching
swimmers with cognitive or emotional disabilities.
Class size affects the amount of time it takes to orga-
nize practice sessions, get everyone’s attention, hand
out equipment, provide feedback, and practice drills
and activities. This subsequently affects the amount of
time for learning and thus lowers the number of objec-
tives and skills that can be achieved in any particular
lesson. A smaller class size helps swimmers who have
attention difficulties, understanding difficulties, and
poor motor skills because a small group has more time
for repeat practice trials; more time for explanations,
demonstrations, and feedback for each student; and
more time for optional skill and fitness components
(ARC, 2004b). The following questions and recom-
mendations on class size may help aquatics instruc-
tors determine how many individuals should be in
any particular aquatics class. You can adapt them to
specific situations as you strive to meet standards for
best practice.
Questions to Address Before Determining
Group Size
• How large is the available pool space?
• How many lifeguards are on deck?
• What is the instructor-to-participant ratio set by
the program or organization?
• What support staff and equipment are avail-
able?
• What are the ages of the participants?
• What are the aquatic abilities in the group?
• Can the participants stand on the pool bottom
with their faces above the water?
• Can the participants independently hold the
edge of pool?
• How many individuals in the group need
intense individualized instruction?
• Are there any participants who require a very
small group environment?
• Are there any participants who have an intense
need for behavioral or emotional support?
• Are there any participants who are extremely
fearful?
• What medical needs (e.g., for seizures, diabetes,
hemophilia) do the participants have?
• Are coinstructors, assistants, adjuncts, or peers
available to help?
Recommendations for
Group Size
Children Aged 6 Months to
4 Years
For 1 instructor, there can be 10 parent (or
caregiver) and child pairs; assign only 5 parent
and child pairs per instructor if children have
exceptional physical, cognitive, or behavioral
needs.
Although infants under 6 months do par-
ticipate in water play, the ARC, Council
for National Cooperation in Aquatics, and
American Academy of Pediatrics do not
recommend their participation in organized
water orientation and play classes. The Ameri-
can Academy of Pediatrics (2000) says that
children should not enroll in formal swimming
lessons before they turn 4 years old.
Children Aged 4 to 5 Years
Attending Without Caregiver
For 1 instructor, there can be 5 to 7 children if
the water is less than chest deep; assign 4 to
5 children per instructor if the water is more
than chest deep.
Children Aged 5 Years and Above
Assign 10 participants per instructor; subtract
approximately 1 to 2 swimmers from the group
for each of the following questions that you
answer with a “yes”:
❚ Is there a participant who has attention
deficit disorder or distractibility?
❚ Is there a participant who has seizures?
❚ Is there a participant with physical dis-
abilities that affect balance, motor
control, head or posture control, or the
ability to stand on the pool floor or hold
onto the gutter?
❚ Is there a participant who needs a sign
language interpreter?
❚ Is there a participant who has vision
issues?
❚ Is there a participant who currently has
or has had an IEP?
❚ Is there a participant who has impulsivity
or runaway behavior?
❚ Is there a participant who has poor
mouth closure, primitive reflex retention,
or excessive water ingestion?

The greater the number of health, safety, cogni-
tive, physical, and behavioral issues there are in a
particular group, the smaller the group should be.
The guidelines for group numbers in the sidebar on
page 58 are based on age and then on ability, medi-
cal, health, and disability considerations.
Your state’s department of education has maximum
class size mandates for classes in which individuals
with disabilities are enrolled. These class sizes and
teacher-to-student ratios are generally listed by type
or severity of disability, such as physical disability or
social and emotional disability. When applying these
ratio guidelines to aquatics, consider the maximums
cautiously, however, because some exceed recog-
nized standards such as the ARC (2004b) maximum
of 10 students per instructor.
Another principle to help guide group size and
makeup is natural proportions. Natural proportions
suggest that the typical distribution of people with and
without disabilities that naturally occurs in the general
population be maintained in inclusion groups (Block,
2000). Since 10% to 15% of school-aged children
have some type of disability, an inclusion group of 10
children might have no more than 1 swimmer with a
disability that requires adaptations or special attention.
Class size and makeup are also influenced by the dif-
ficulty of the skills to be presented, the discipline issues
within the group, and the experience that the instructor
and entire group have with inclusive group functioning
(Conatser et al., 2000). When placing a participant who
poses a challenge to aquatics group structure, com-
munication, or safety, limit the number of participants
without disabilities according to the answers to the
questions already discussed. Each situation is unique.
Careful assessment of the individual, proper planning,
and effective communication with family, caregivers,
and professionals who work with the participant are the
keys to developing successful inclusion groups.
Task Presentation in Inclusion
Groups
Although the activity should be age appropriate, you
should base the difficulty of the concepts and skills
and your presentation of them, including your teach-
ing methods, cue words, expressiveness and detail of
instruction, and chosen learning modes (e.g., visual,
auditory, tactile) on functional or developmental age.
When planning lessons for any aquatics class, but espe-
cially for classes including participants with physical or
cognitive disabilities, you must analyze the activities,
tasks, and progressions that you wish to present. Activity
analysis is thinking about the physical, cognitive, and
social requirements of each activity. For each activity,
Inclusion and the Least-Restrictive Environment 59
write out the required physical aspects, or the motor
movements and physical fitness demands. Next, estab-
lish the cognitive abilities that each activity requires,
such as the ability to follow directions, remember rules,
know right from left, understand simple directions in
space, plan strategies, read, sequence numbers, and
interpret verbal and nonverbal communication. Finally,
list the possible social requirements, such as skills in
cooperation, rule following, displaying acceptable win-
ning and losing behaviors, getting along with others,
and waiting for a turn. The activity analysis is complete
when you have listed all the physical tasks that must be
performed and the cognitive and social prerequisites for
basic success in that activity. Following activity analysis
is the analysis of each task. Task analysis is necessary for
part–whole and progressive-part teaching styles. Each
of the tasks is broken down into simpler steps so that
participants can successfully reach the terminal (target)
behavior or action. The target skill may be an aquatic
physical or cognitive skill; an auxiliary skill such as
dressing, washing, or toileting; or a social behavior. You
must present the tasks in a progression that is acceptable
to the entire class as well as to individuals who may have
disabilities that preclude them from functioning at the
same level. Often aquatics instructors fail to distinguish
between the activity analysis, task analysis, and teaching
progression. See the example analysis and progression
for raft ball on page 60 to get started. See also figure 3.8
for a photo of a raft ball.
Figure 3.8  Inclusive recreational aquatic activities,
like raft ball, may need an activity analysis and a task
analysis.
 Activity Analysis, Task Analysis, and Progression
for Raft Ball
In raft ball, participants lie on blow-up rafts and
paddle with their arms. They try to scoop up a
small beach ball and pass it to their teammates.
Someone tries to swim the ball over the goal line
while on the raft.
Activity Analysis of Raft Ball
Necessary physical skills for raft ball include the
following:
❚ Butterfly or front crawl arm stroke
❚ Backward push stroke (like a backward
butterfly)
❚ Balanced reach for the ball
❚ Ball toss to partner
❚ Ball scoop
❚ Ball catch
❚ Swimming with the ball while on the raft
❚ Righting self after falling off the raft
Necessary cognitive skills for raft ball include the
following:
❚ Awareness of group and concept of
team
❚ Ability to remember which goal to aim for
❚ Ability to quickly switch roles from defense
to offense
Social skills necessary for raft ball include the
following:
❚ Ability to share the ball with other team-
mates
❚ Ability to use the right amount of assertive-
ness (versus aggressiveness) for defense
and offense
❚ Self-confidence, so as not to be intimidated
by the others
❚ Cooperation with instructor and peers
❚ Ability to follow the rules
❚ Maturity to handle own strengths and
weaknesses as compared to those of other
players
60
Task Analysis of Raft Ball Skills:
Butterfly Arm Stroke on Raft
1. Balance on stomach on raft, head raised,
arms in water, for 10 seconds.
2. Perform step 1 but with people nearby
splashing water all around.
3. Lift both arms simultaneously out of the
water while balancing on stomach on
raft.
4. Place hands in water in front of the shoul-
ders, arms extended.
5. Pull arms back and slightly under raft in
order to propel raft forward.
6. Pull stronger with one arm to make turns.
Progression for Teaching Raft Ball
1. Instructor supports raft while participant
gets on and lies on stomach.
2. Instructor pulls raft around pool while par-
ticipant maintains balance.
3. Instructor encourages participant to look
ahead and put arms in water while being
pulled around.
4. Instructor encourages participant to
place feet in water in various positions to
feel balance changes while being pulled
around.
5. Instructor encourages participant to keep
balance while being pulled around and
instructor makes turbulence.
6. In a stationary position, instructor demon-
strates proper arm position while participant
sits on steps, side of pool, or water chair.
7. While floating on the raft, participant tries
arm position.
8. On raft, participant tries arm stroke across
pool.
9. On raft, participant paddles the length
of the pool with others swimming around
him.
10. On raft, participant paddles the length of
the pool with others in his way.

How do you determine which activities and tasks
you must analyze? Look at the assessment and the
IAPP (see chapter 4). See what skills and activities
the participant and caregivers would like developed,
what skills are necessary to be included with peers,
what therapeutic and healthful activities are desir-
able, and what your program offers in these regards.
Once you know how your program matches the
participant’s needs, you should target and analyze
the related activities and skills. Then ask yourself,
“How many steps should I break each task into?”
The answer depends on the individual’s functioning
level and the severity of the physical, cognitive, and
social challenges of the disability. You must use your
professional judgment and the information gleaned
from the assessment to decide how, when, and how
much to analyze a task.
Using Activities to Facilitate
Inclusion
Participants find success and satisfaction in aquatics
activities that are challenging yet attainable. Although
the basics to successful inclusion are instructor com-
petency and attitude; resource, technical, evaluation,
and moral support; and effective progression and
Table 3.1
General Versus Inclusive Aquatics Programs
General
One standard for all (everyone swims the same stroke, and
there is only one correct way to do that stroke)
Same activity or game for all (everyone has to play tag while
treading water in the deep end of pool)
Same equipment for all (everyone has to use the same
kickboard)
Regulation rules for games (there is only one correct way to
run a relay race or play a water tag game)
Reprinted with permission from the May/June 2002 issue of the Journal of Physical Education, Recreation & Dance, a publication of the American
Alliance for Health, Physical Education, Recreation and Dance, 1900 Association Dr., Reston, VA 20191 (www.aahperd.org).
Inclusion and the Least-Restrictive Environment 61
presentation of tasks, safe and enjoyable activities
make the entire package work. Activities and teach-
ing styles embracing the inclusive philosophy utilize
many performance standards—not just one standard
for all—so that people can participate on whatever
level they are capable of. Don’t insist that swimmers
master the activity in one exact way; instead, stress
that people perform aquatic activities to the best
of their ability and, most of all, stress enjoyment.
Mosston was famous for developing this concept,
illustrated by the slanted rope activity, in which
the instructor asks participants to jump over a rope
held in the air by two people (Mosston & Ashworth,
1986). The rope is high at one end to challenge the
more advanced jumpers and lower at the other end
to accommodate the less skilled jumpers. When you
find ways like this to accommodate abilities, you can
use the same activity with little modification, thereby
including and challenging all participants without
singling out any individual. Moreover, allowing the
participants to choose their level of difficulty puts
everyone at ease, whether or not they face special
challenges. Table 3.1 describes examples of general
versus inclusive practices (Block & Conatser, 2002)
that help to illustrate this idea. In the following sec-
tions, we’ll identify common principles to guide
you as you develop inclusive activities (see specific
activities in appendix C).
Inclusive
Multiple standards (students are allowed to choose strokes
that match their abilities or goals, and modified strokes are
allowed and encouraged when necessary)
Choices in activities and games (deep water tag as well as
shallow water tag and volleyball is offered)
Choices in equipment (students can choose from a variety of
floating aids)
Modified games (rules are created that allow full, safe, and
successful participation by all students, even if modifications
include changing the number of players per team, changing
the boundaries, changing movement requirements for
individual students, etc.)
62 Adapted Aquatics Programming
Planning Developmentally
Appropriate Games
Effective teaching behaviors—such as organizing
structured lessons with smooth transitions, using an
animated teaching style, providing concise and clear
directions, and developing accurate demonstrations—
and heightened interpersonal skills are important to
the success of inclusive aquatics. But a great game
really pulls a lesson progression all together! Games
and activities lend themselves to high participation
and motivation to learn tasks. We cannot stress
enough that your attitude, organization, and prepa-
ration are key factors in designing games for inclu-
sion. Most critical is how you apply what you know
and feel in the learning environment. One sensitive
way to approach games in the inclusion setting is to
focus on cooperative rather than competitive learning
activities. For example, downplay being the fastest
or the winner (such as in relays and other races) and
emphasize being the best you can. Avoid elimination
games and activities in which the individuals with the
poorest skills are out first.
The opportunity for learning during games is
powerful if you carefully consider the needs of all
participants during planning and implementation.
A playful atmosphere—even when working with
adults—decreases pressure on those who don’t
perform as well as others do (ARC, 1977). More-
over, putting skills to use in activities and games is
a natural motivator and reinforcer. To this end, you
must remember to continue to teach during the game
or activity, avoiding turning it into mere free time.
“Aquatic games are not rote drills, highly structured
competitive sports, or relay races. They are activities
that all can enjoy, are active, and serve a purpose”
(Langendorfer, German, & Kral, 1988).
You can modify any activity that you have previ-
ously taught by using Morris and Stiehl’s games analy-
sis model (1989), which facilitates finding more than
one way for participating in an activity or changing
an activity from a competitive to a cooperative one.
Morris and Stiehl listed six components that you can
adapt, including (1) the number of participants who
are playing, (2) the equipment used in the game, (3)
the movements used for participation, (4) the patterns
of organizing the participants in the activity, (5) the
limitations of the activity, as seen in rule changes, and
(6) the purpose, in terms of the goals and objectives,
of the activity. If you have an individual who cannot
participate in water volleyball or in Marco Polo, for
example, brainstorm (and even ask participants)
about adaptations for any of the six components to
make the game more inclusive and developmentally
appropriate for each participant. Use the example of
Example of the Games
Analysis Model
Game: Marco Polo
How To Play
The person who is It wears a blindfold or closes
his eyes. He continues to say “Marco” and
the other players answer “Polo” until he can
locate players by sound and tag another
player, who then becomes It. To avoid being
tagged, the other players try to swim around
and under the water in a designated area
after they say “Polo.”
Adaptations
❚ Players: Having more players means
more chances to succeed. The makeup of
the group, through ability grouping or size
and strength grouping, can lead to greater
success for each participant.
❚ Movements: Having more proficient
individuals swim a certain way, such as by
sculling on the back, can equalize the game
for individuals who are slower movers.
❚ Equipment: Using a life vest or tire tube
can help individuals with severe physical dis-
abilities enjoy this game. Using a foam reach-
ing pole can assist an individual who is It but
has a limited range of motion.
❚ Organizational pattern: Limiting the play-
ing space and cordoning off the playing area
can put players with limited mobility and sight
in a better position to have an equal chance
to succeed at being It.
❚ Purpose: Changing the purpose of a
game (to develop judgment, to improve audi-
tory focusing, or to improve changing direc-
tion in the pool) can allow you to accommo-
date individuals’ specific goals—for example,
to improve underwater swimming, you can
have everyone swim underwater.
❚ Limitations (rules): Changing the rules
can help you accommodate specific abilities.
When an individual with mobility impairment
is It, you can limit all players by allowing them
to only move one step in any direction after
saying “Polo.” When an individual who is hard
of hearing is It, you can require players to
splash gently toward It. When an individual
who uses a flotation device is It, you can ban
players from going underwater. You can also
limit the number of times a player can be It
to two times per game so that the slower indi-
viduals aren’t tagged as It all of the time.

the games analysis model on page 62 to help you
modify games and activities.
Remember, when using games analysis or coop-
erative games, planning for successful experiences
is a must. Realistic expectations, consistent instruc-
tions, clarity of class rules and procedures, and play
areas set up for maximal safety and participation can
increase the time involved in instruction and practice.
If you are conducting a general aquatics class that
includes individuals with intense learning needs,
structure the management, transitions, and practices
so that all individuals actively pursue the objective of
the lesson and the individualized program for at least
two thirds of the class time (Wessel & Kelly, 1986).
Ensure that proper placement, appropriate physical
and learning support, and effective teaching mesh to
produce a setting that maximizes the learning time
for all participants. The following suggestions are
from Achievement-Based Curriculum Development in
Physical Education (Wessel & Kelly, 1986). Use them
to maximize the time spent on task in the included
aquatic setting.
• Have equipment ready before participants
arrive.
• Provide enough equipment for each partici-
pant.
Figure 3.9  Children with disabilities enjoy props with which they get to interact.
Inclusion and the Least-Restrictive Environment 63
• Use location cues for where you want the
students to go when moving from one place
to another.
• Use signals that all can understand to stop and
start activity.
• Use physical assistance if necessary.
• Use parents or caregivers to take students to the
restroom, move equipment, and count laps.
• Adapt distance, time, equipment, and move-
ment for participants with fitness and motor
skill limitations.
Activity Suggestions for Various
Age Groups
Although most aquatics participants are looking for
enjoyment and relaxation, the developmental and
chronological ages of swimmers affect what activi-
ties they choose to do in the pool. Younger children
enjoy toys, blow-up floats, and other props, while
older children like self-challenge, competition, and
fast-paced, daring adventure (see figure 3.9). Older
swimmers most often focus on fitness, rehabilitation,
and relaxation. The following sections introduce
generalizations about various age groups, the types
of activities they engage in, and individuals with
disabilities in each group.
Photo courtesy of Christine Stopka
64 Adapted Aquatics Programming
Children Aged 6 Months to 3 Years
Infant, toddler, and preschool children with dis-
abilities may have developmental delays that hinder
their participation in aquatics programs. Lack of head
control can cause the face to flop close to the water.
Low muscle tone in the trunk can lead to inadequate
sitting and upright posture control. Poor oral motor
control, causing children to swallow water, and
underdeveloped respiratory systems, causing children
to have trouble coughing out inhaled and swallowed
water, can lead to taking water into the lungs or
stomach. Excess ingestion of water can lead to hypo-
natremia, a sodium imbalance. As recommended by
the American Academy of Pediatrics, children under
4 should not have formal instruction in swimming.
Water play, including parent and child water orien-
tation and exploration, is a fun way for parents to
bond with their children. Actual instruction of swim
strokes and any programs touting drown proofing
or waterproofing should not take place before the
fourth birthday. Children with a developmental age
under 4 years should be supervised one on one by
a teacher, assistant, paraeducator, or aide during all
group instruction.
Orient children with and without disabilities to the
water gently and allow them to be accompanied by a
parent, guardian, or caregiver. The group size should
be no more than 10 pairs per instructor. The holding
techniques in the parent and child swimming sections
of the Water Safety Instructor’s Manual (ARC, 2004b)
are excellent training tools. These programs are not
about learning to swim or drown proofing. Songs,
games, and water orientation activities, as well as
parent or caregiver safety and child safety, comfort,
and fun, are the mainstays of the classes.
Children Aged 4 to 5 Years
Many children with disabilities who are 4 to 5 years
old can function without being one on one with a
parent, but they still require a one-to-one assistant
within a very small group of 2 to 3 children. Children
of this age with disabilities often need extra assistance
and can benefit from having an additional certified
swimming instructor or an adapted aquatics instructor
in the group. They may also require a water table if
the pool depth is above their chins. For children this
age, keep verbal directions to a minimum: Use visual
demonstrations as the primary means to teach. Giving
short verbal cues directly to the individual rather than
the whole group, however, can be very successful.
Children with developmental disabilities do not usu-
ally have the ability to participate in cooperative play
at this age, but they might be ready for parallel play
and somewhat cooperative ventures such as sharing
a floating mat to kick across the pool. A large number
of swimmers with disabilities at this age may still use
swim diapers.
Children Aged 6 to 8 Years
Children ages 6 to 8 generally enjoy the water and just
about any activity that you might present. At this age,
typically developing children are beginning to keep
themselves afloat in deep water, jump into deep water
independently, and swim for long distances (maybe
up to 25 yards, or 22.9 meters). You must ensure that
individuals with disabilities who are included in the
general aquatics class have the prerequisite skills to
benefit from the instruction and have a safe and suc-
cessful experience, or that the participant without
prerequisite skills has the proper physical and learn-
ing support. At this age, children with developmental
disabilities may need additional adapted aquatics
sessions outside the general aquatics class in order
to work more individually on specific needs.
Children Aged 9 to 11 Years
In general, children ages 9 to 11 who have disabilities
and have been exposed to swimming for a few years
have mastered some way to keep themselves afloat.
Children with disabilities in this age group may be
more mobile because they can touch the bottom of
the pool, perform a unique version of the dog paddle
or double-arm backstroke, or tread water. However,
these children begin to find themselves physically at
a disadvantage when compared with their peers due
to the physical or cognitive complexity of the skills
presented in the classes. At this age, children without
disabilities generally function at an ARC swim level
3, 4, or 5. Thus, children who are included with
same-aged peers but do not have the prerequisite
skills will need help refining the skills that they have.
In addition, because at this age girls and boys begin
to become aware of physical differences in strength
between genders, you will need to adapt the activi-
ties you choose for many aquatics participants with
or without disabilities.
Children Aged 12 to 14 Years
Participants who are 12 to 14 are looking for accep-
tance and adventure. They do not want to fail around
their peers and often prefer to show off skills that they
already know unless the atmosphere is emotionally
safe for them to try new ones and fail. They are beyond
baby games and think that they are much too sophisti-
cated to even be in swim class, let alone play a game.
At this point, you should refer to games as activities
or challenges to promote cooperation. If swimmers
with disabilities are included with same-aged peers,

they often are not near the same swim level and need
alternate activities during lessons, or flotation devices,
to be successfully included in activities.
Teens and Young Adults
People without disabilities who are 15 years and older
usually do not participate in swim lessons, making it
difficult to create age-appropriate inclusion groups for
swim lessons. Teens and adults typically participate in
aqua aerobics; in single-focus activities such as water
polo, diving, synchronized swimming, recreational
swimming including fitness swims, aquatic stunts, and
fooling around; and in competitive swimming.
At age 15, many individuals with disabilities find
themselves at a proverbial fork in the road. Activities
that their same-aged peers participate in tend to be
team sports and competitive games. Activities that are
instructional and noncompetitive are usually offered
in segregated programs catering to the needs of indi-
viduals with disabilities. Moreover, in these years the
difference in skill level between people with and with-
out disabilities tends to grow, and many individuals
with disabilities find themselves lacking skills needed
to safely participate. Aquatics instruction during the
late teen and early adult years may take place only
in high school physical education classes, college
physical education required courses, summer camps,
and segregated instructional programs for individuals
with disabilities.
Remember that teenagers and adults under age 22
with disabilities have formal ITPs to prepare them for
other activities in the community. Whenever possible,
advocate adding swimming and water safety to the
transition plan. Write goals and objectives that the
participant needs to accomplish in order to function
as fully as possible at the local pool in the aquatics
programs she may choose to join. Choice is vital to
self-esteem and self-actualization. Ensure that young
adults (and other adults) receive sufficient orienta-
tion to aquatic opportunities, so that they can make
informed decisions for themselves. Thus, instructional
programs in schools that lead to adulthood and transi-
tion should expose participants to a variety of experi-
ences as well as work to improve specific skills.
Adults
By adulthood, needs vary among individuals with
disabilities even more than they vary in the general
population. Moreover, as with adults without disabili-
ties, adults with disabilities differ from teenagers and
children in their goals, attitudes, and desires. Adults
may be motivated by many different factors to attend
an aquatics program. The primary concern is usually
fitness or a focused skill such as scuba diving. In this
Inclusion and the Least-Restrictive Environment 65
section, we’ll discuss issues that commonly arise
when attempting to include adults and teenagers with
disabilities in water exercise or competitive, instruc-
tional, and recreational aquatics programs (see also
chapters 10 and 12).
In aqua aerobics, as in any included setting, indi-
viduals with disabilities and their advocates must
determine how much support is needed (if any at
all) in the locker area, on the pool deck, and in the
program itself. As the instructor, you should compose
a list of the typical movements that the exercise
class performs. Then you should demonstrate the
movements to the individual and perform a skills
assessment. Perhaps the participant should spend a
few sessions working on those skills with the adapted
aquatics instructor, then move into the class with
the adapted aquatics instructor as support, and then
finally, if able, participate independently with adapted
equipment or other support.
Although we generally discourage using competi-
tion for teaching skills in instructional programs, an
entire aquatics option exists for people with disabili-
ties in the competitive arena. Segregated competitive
programs serve almost every type of disability, and
integrated competitive opportunities exist, fostered
by USA Swimming (see chapter 12.)
Adults may find an occasional beginner swim class
offered in a continuing education program, but these
classes are few and far between. How, then, can you
help the adult with disabilities learn to swim? Tips for
including adults and teens in instructional programs
in high schools and continuing education programs
follow the same principles we’ve been advocating in
this chapter. In universities, a different scenario exists,
as individuals with disabilities tend to have more
physical or sensory disabilities and fewer intellectual
disabilities. In the university setting, you’ll generally
find greater support for your teaching due in part to
a campus office providing services to students with
disabilities. You’ll also be more likely to be able to
offer integrated instructional programs in swimming,
canoeing, and scuba (see chapter 12).
Although many games are unsuitable for teen and
adult participation, you should still create activities
to reinforce skills. You can use the following ideas in
any aquatics program to make it more fun and age-
appropriate for teens and adults.
Using music that is popular with the group is a
common means of making activities age appropri-
ate. Put a fast-paced song on when participants are
treading water and ask them to tread for the whole
song. Incorporate dance steps into water exercises,
especially ones that can transfer into community
dancing.
66 Adapted Aquatics Programming

Use adult-type equipment. Hoops, sinkable flow-
ers, and animal floats are children’s toys, while inner
tubes, wet vests, coins, and water-ski belts are more
suitable for adults. Don’t forget to use age-appropriate
names for activities.
Age-appropriate aquatics programs, whether
included or segregated, that serve adults should strive
to treat individuals with the respect and dignity that
they deserve as adults. Preserve dignity by encourag-
ing choices, providing socially appropriate experi-
ences, and speaking in respectful tones.
Summary
Aquatics instructors and programs cannot make
excuses for not having the knowledge, equipment, or
services to facilitate access for individuals with dis-
abilities to pools and other swim facilities. Individu-
als with disabilities should have access to programs,
classes, and activities with people without disabilities.
In this chapter we presented guidelines to help you
assimilate individuals into aquatics programs and
establish an inclusive atmosphere while striving for
the least-restrictive environment. It is possible to
develop and maintain inclusive programs, classes,
and groups by assessing the individuals you’re striving
to accommodate, preparing fully, providing adequate
support within the aquatic environment, adjusting
group size, and presenting lessons appropriately.
Avoid the common trap of using aquatic games
and activities as time fillers rather than as carefully
planned steps to enhance aquatic or movement skills.
With forethought, games and activities can replace
drills and repetitive practice sessions that may lead
to boredom or discouragement. Use the suggestions
in this chapter to adapt existing aquatic activities. Be
creative and have fun!

Chapter 3
Review 1. Discuss the concepts of appropriate placement, array of services, inclu-
sion, and least-restrictive environment.
2. What does the term creating inclusion refer to? List the three areas that
aquatics programs must examine to begin creating inclusion.
3. Explain environmental prerequisites that allow a participant with a disabil-
ity to safely and successfully be included in an aquatic setting along with
individuals without disabilities.
4. Which health or medical concerns may hinder inclusion in a general
aquatic setting?
5. What are some program prerequisites that are required for successful
inclusion?
6. Discuss the concept of chronological age appropriateness.
7. According to research, what are the three factors that most aquatics
instructors feel are needed for successful inclusion?
8. What supports do aquatics instructors need to be successful in teaching
inclusive swim groups?
9. What are activity analysis and task analysis? How do these two concepts
contribute to the success of inclusive swim groups?
10. List some best practices and suggestions for developing games and activ-
ities for the inclusive swim group.
 4
Individualized
Instructional Planning

M rs. Denny had a dilemma. It seemed that her 12-year-old son was being
excluded from the 12-week swim program that all sixth graders in the
school district were participating in. The district’s aquatics staff was overwhelmed
by the notion of what Mrs. Denny’s son Ry could possibly learn since he was a
student with challenging behaviors in the autistic spectrum and was large in size
for his age. The aquatics staff members did not send the permission slip and swim
lesson notice home to Ry’s parents since they did not feel that he was able to be
involved in the swim program. They had formed this opinion of Ry while observing
him in community events and church-related programs.
When Ms. Denny protested that her son would receive the services that every-
one else in sixth grade received, an adapted aquatics specialist was called in
to conduct an assessment, suggest placement, and write goals and objectives
for inclusion in the boy’s IEP. Following a successful assessment that the adapted
aquatics consultant conducted, with Ry’s entire IEP team and parents present,
the aquatics staff apologized for the stereotype, embraced the recommenda-
tions and goals from the assessment, and formed a small group for Ry to learn in
during the swim program.

67
68 Adapted Aquatics Programming
T he opening true-life scenario with Ry demon-
strates the importance of setting written goals and
objectives in the IEP or IAPP. Critical to implementing
programs that are safe, effective, and relevant is the
underlying notion that the people in charge have
planned for success, ensuring that the aquatic learn-
ing environment is at its best. In planning for success,
best practice dictates designating the curriculum and
model for service, creating or adopting tools to assess
participants, and coordinating day-to-day functioning
of the instructional program, including individual and
group programming. In this chapter, we’ll introduce
best practices in individualized instructional plan-
ning, including planning for assessment; developing
the aquatics portion of the IEP, which we call the
Individualized Aquatics Program Plan (IAPP); and
developing strategies for implementing the plan. Keep
in mind that individual assessment and individualized
lessons meet the spirit of the ADA’s mandate to offer
reasonable accommodations.
Accommodating individuals with disabilities in
aquatics begins with defining what skills a participant
needs to learn and assessing her present performance
of those skills. Whether teaching an exercise, a swim
stroke, or circle swimming in a lane, as the aquatics
specialist you must plan out the goals, objectives,
strategies, activities, equipment, and evaluation
needed for the long-term (annual) goals (in the IAPP)
as well as for each session. Daily or weekly lesson
plans are developed from the interaction between the
swimmer’s IAPP or IEP and the goals of the aquatics
group that the swimmer participates in. Any lesson
plan format is acceptable as long as the plan helps
you meet your lesson goals and transition from one
activity to another in a safe and timely manner.
Chapter Objectives
From this chapter, you will learn the
following:
* Planning for an adapted aquatics
assessment involves gathering back-
ground information about the swimmer,
determining what types of aquatic skills
the swimmer and family want to learn,
and developing an assessment tool.
* Differences in the skills assessed in the
various models of adapted aquatics are
dependent on the goals and philosophy
of the program.
* Developing an aquatics Individualized
Education Program (IEP) involves review-
ing the present level of performance,
writing goals and objectives, determin-
ing modifications and specially designed
instruction, and making recommenda-
tions for placement in a class.
* When writing goals and objectives for
adapted aquatics, select and prioritize
goals, determine a logical sequence,
and include specific criteria for measur-
ing the objective.
* To achieve individual goals within a
group setting, try to pair students with
similar goals, communicate goals to the
swimmer and any assistants, and put the
swimmer in a class with goals that best
match the swimmer’s goals.
Planning for Assessment
When determining what a swimmer should learn,
you must begin by systematically discovering what
the swimmer knows and can do. An aquatic assess-
ment is needed to determine the swimmer’s present
performance, the appropriate group placement, and
the necessary support services. Assessment, or test-
ing, of a participant describes the collecting of data
through formal and informal observations. Along
with interviewing and reading background records,
gathering information through testing provides the
basis for making decisions regarding placement and
instructional planning.
Naturally, before performing the actual aquatic
assessment, you should determine what skills you
will assess. To prioritize your assessment, ask yourself,
“What is the participant interested in learning? What
skills do the caregiver believe are important for the
participant to acquire? Where will the participant use
the learned skills outside of class? What are same-
aged peers without disabilities doing in aquatics
classes? What equipment is available to the family?
What are the medical, therapeutic, educational, and
recreational needs of the participant?” After writing
down the answers to these questions, look them over
and determine what activities and concepts they
have in common—these are the priorities. Develop
assessment items that will determine the participant’s
present level of performance in these skills. Table 4.1
shows an example of prioritizing assessment skills
for a 12-year-old boy with mild hemiplegia cerebral
palsy. This boy can hold his breath with his face in the
water for 15 seconds, doggie paddle in deep water,
 Individualized Instructional Planning 69

jump into chest-deep water and then perform a modi-
fied front crawl for 15 feet (4.6 meters), roll from front
to back, and move as if treading water with flotation,
but he often sucks in water when he startles due to
splashing or an unexpected dunking. A look at the
participant’s present level of motor skills as well as
the skills included in table 4.1 will help the instructor
decide what is most important and therefore what
to assess. Deciding what the participant will master
is paramount so that you can eliminate less helpful
items and target functional skills critical to success
(Block, 2000).
After the aquatics instructor interviews the boy
and his caregiver, she reviews the current physical
and occupational therapy goals and the goals from
the student’s physical education class at school. The
boy’s target skill information is included in table 4.1.
In addition, typical aquatic skills that 12-year-olds
perform while swimming are listed. Finally, the last
column lists skills that this swimmer needs if he will
someday participate in an inclusive aquatics pro-
gram. When all the skills are listed, it is easy to see
which ones are higher priorities due to their being
mentioned in more than one context. The aquatics
instructor determines that assessment should focus
on the following skills:
• Strokes with underwater recovery
• Bobbing and breath control
• Mouth closure while jumping and falling in
• Strokes for long distances
• Balancing on tubes and rafts during ball play
• Adapted leg action for treading water
• Deep-water comfort skills and jumping from
the poolside and diving board (with an assistant
on deck)
Once you have collected the assessment data, view
them in the context of the big picture. Use some or
all of the answers to the following questions to help
you accurately evaluate test results:
• How should I compare the assessment data to
previous data?
• How should I compare the data with data for
other participants?
• How should I use the data to determine where
the person will experience the most success in
learning aquatic skills?
• How should I use the data to determine mean-
ingful gain or mastery?

Table 4.1

Determining What Skills to Assess

Skills the swimmer Skills the care- Medical or thera- Activities same- Skills the par-
is interested in giver believes peutic needs aged peers are ticipant needs for
important doing in aquatics inclusion in aquat-
ics class
Jumping off the diving Surviving a fall into Has decreased Divind and jumping Feeling comfortable
board the deep end flexibility due to off the diving board in deep water and
spasticity propelling self
through water

Swimming in the Treading water and Mouth closure Swimming laps, Attaining proficiency
deep end swimming to the side problems when falling treading for 5 min, in level 4 or 5 ARC
of the pool in the from or jumping from playing water skills
deep end the side or being basketball or water
splashed polo

Playing water Swimming skills Poor balance, startle Practicing the Holding the side
basketball for playing any reflex, poor range of butterfly, performing of the pool during
game with peers motion, bicycle kick in time trials or races, waiting, getting in
during recreational action during flutter swimming for objects and out of the pool
swimming kick, high muscle on the bottom of the independently, using
tone, and high body pool, playing tag all swim strokes,
density games, dunking each performing the
other in tubes and beginning diving
rafts sequence, and using
preliminary water
safety skills
70 Adapted Aquatics Programming
• How should I use the data to determine what
skill components the person should practice
next?
• How should I use the data to determine the
feedback for individual stroke propulsion
mechanics?
Most often, assessment in adapted aquatics is
used to determine specific goals and objectives and
the “appropriateness of placing students into regular
classes, since it is this extrinsic standard against which
all other students in regular classes are compared”
(Seaman & DePauw, 1989, p. 130).
As an aquatics specialist, you can, depending on
the situation, compare an individual’s testing infor-
mation to past results for the same individual, data
on other individuals, or preestablished criteria. You
can then project the desired outcomes, decide the
most appropriate learning environment, and plan for
instruction. Finally, given that instruction and ongoing
assessment are synonymous, you need to continue
gathering information about an individual’s perfor-
mance, evaluate that information, and continuously
make decisions as to placement, support services,
and projected goals and objectives.
What you assess and how you assess will be dic-
tated by the model under which you are working and
by the desires of the swimmer and his family. Other
things that will influence the assessment are the pro-
gram goals, the available facilities and equipment,
your expertise, and the individual’s age, needs, and
capabilities. In the following sections, we’ll look at
the particulars of assessment in regard to each of the
four models introduced in chapter 2.
Medical-Therapeutic Model of
Aquatic Assessment
Remember that the medical-therapeutic model
focuses on treating specific, diagnosed problems.
In general, medical-therapeutic aquatic assessment
uses specific movements, prescriptive exercises,
anatomical positions, and ambulation to indicate an
individual’s present level of functioning. The assess-
ment battery may also include basic swimming, water
safety, and socialization skills, but in general these
aspects are not the primary focus. As you will see,
each specialist working under this model approaches
assessment in a slightly different way.
Occupational Therapy
An occupational therapist (OT) with aquatics exper-
tise may develop an instrument for collecting data
on self-help skills, equipment use, reflex involve-
ment, swim ability, pain relief or exacerbation with
movement, abnormal muscle tone, muscle spasms,
posture and positioning, sensory integration, hand
functioning, strength and endurance, oral control,
motor control, facial control, balance, edema, joint
stability, relaxation, mobility, play skills, bilateral
motor coordination, and gravitational security.
On land, an OT chooses from many assessment
instruments that measure developmental or functional
abilities. Developmental instruments, which are
generally used with a pediatric population, look at
skills based on motor development and at underlying
causes of problems such as sensory integration issues,
balance and vestibular disorders, and skill acquisi-
tion from a developmental point of view (bottom-up
approach). Functional instruments are based on
current and future tasks of daily living. Functional
assessment is typically used with adults and teens,
but more often a combination of developmental
and functional tests are used with children. An OT
will most often evaluate an adult with checklists for
land-based functional skills, vocational tests, tests
of manual dexterity, activity and task analyses, and
tests for range of motion, balance, strength, and
endurance. When testing the adult in water, the OT
may evaluate the differences in land versus water
performance in all of the aforementioned areas, taking
notes about vestibular, visual, auditory, propriocep-
tive, and tactile reactions to the pool environment.
The OT may also observe the individual’s manipula-
tion of pool toys and equipment such as kickboards,
hand grasp of pool gutters and railings, head and
body control during locomotion, and propulsion in a
gravity-reduced environment. Figure 4.1 is a sample
form for an occupational therapy assessment of
aquatic behaviors and skills.
Besides providing actual aquatic therapy, the OT
conducts land exercises in the pool to increase moti-
vation (see figure 4.2). Patients who are working on
sitting balance while manipulating equipment or toys
can be brought to the pool as a way to avoid burnout
from traditional land therapy. OTs have discovered
success with water therapy even with the most dif-
ficult and frustrated patients, due to the relaxing
atmosphere and the elements of fun (Smith, 1992).
OTs use aquatic therapy to facilitate the same goals
set for land therapy (Mastrangelo, 1992), and there-
fore aquatic assessment by OTs is primarily based on
land assessment with anecdotal notes about the way
the person handles herself in the water. OTs gather
information about the skills that children and adults
need to enjoy an independent and satisfying life.
 4 = Performs independently
3 = Performs with equipment or technique adaptations
2 = Completes but not in a practical time frame
1 = Attempts but requires assistance of the therapist to complete
0 = Does not attempt activity

Child assessment Initial assessment Post-assessment

1. Stair or ramp entrance (circle one)

2. Holds pool gutter

3. “Spidering” (hand-walking) on pool gutter

4. Sits for 1 minute on water table

5. Holds sitting balance while water is turbulent

(1 minute)

6. Grabs and holds toys just out of reach from sitting

7. Stands on water table

8. Holds standing balance while water is turbulent

9. Walks on water table

10. Grasps flotation device

11. Holds and uses flotation device

12. Grasps weighted ring (from standing) on pool bottom

without submerging

13. Tolerates water splashing nearby

14. Tolerates water on face and head

15. Closes lips when putting face in water

Adult assessment Initial assessment Post-assessment

1. Stair, ramp, side entrance (circle one)

2. Holds sitting balance for 3 minutes

3. Ambulates in chest-deep water

4. Runs in chest-deep water

5. Walks backward in chest-deep water

6. Grapevine step in chest-deep water

7. Ball catch with partner while standing in chest-deep water

8. Recovers from fall or swim underwater

9. Closes lips when water is splashed toward face

10. Closes lips when submerging

11. Recovers from supine position (back float)

12. Holds and uses flotation kickboard or barbells

13. Relaxes on flotation device for 2 minutes

Figure 4.1  A sample occupational therapy aquatic assessment.

71
 72 Adapted Aquatics Programming
Photo courtesy of Shawn Stevens
Figure 4.2  Reaching and crossing the midline are occupational therapy goals
that can be adapted to a pool setting.
Physical Therapy
Physical therapists (PTs) vary their assessment to fit
the individual’s diagnosis, current land programs, age,
and cognitive and physical abilities. Since PTs com-
monly use aquatic therapy for postorthopedic surgery
patients, assessments for range of motion and strength
are critical (Framroze, 1991). PTs usually take these
measurements on land because it is hard to measure
them accurately in the water. Patients who have had
extensive bed rest may be deconditioned, and so the
PT will typically assess for endurance.
A PT also assesses ambulation in an aquatic physical
therapy program. A therapist might look at forward,
backward, and sideways walking as well as at running
and stair-climbing. The PT will note positions causing
comfort or discomfort, posture, body mechanics, and
confidence while moving in various depths of water.
The assessment may also include weight-bearing
status, transfer ability, and amount of assistance needed
for activities. Figure 4.3 shows a sample PT referral
form for the therapeutic aquatic program at the duPont
Hospital for Children. This form shows the range of
skills that will be assessed for the program.
Kinesiotherapy
Since kinesiotherapy is a bridge between traditional
therapy and the full return to daily functioning, some
items in a kinesiotherapy aquatic assessment resem-
ble assessment items for physical and occupational
therapy as well as for adapted aquatics
and therapeutic recreation. For example,
the kinesiotherapist assesses patients on
dry land, taking an oral or written history
to assess swimming and floating abili-
ties, exercise capacity, and tolerance for
various positions required in the pool
(Meyer, 2005). Next the kinesiotherapist
asks patients which activities they prefer
to do in the pool. The aquatic assessment
is then based on the patients’ needs in
fitness, leisure, and work settings.
Sports Medicine
In sports medicine, aquatics specialists
ask patients to perform various anatomical
movements that assess whether exercise
should be assisted, supported, or resisted
by buoyancy. For athletes with stress frac-
tures, shin splints, and overuse syndromes
of the lower body, the aquatic sports medi-
cine specialist assesses ambulation, taking
anecdotal notes to record the movements
that cause or relieve pain and the overall
comfort level of the patient in the pool.
Educational Model of Aquatic
Assessment
As stated chapter 2, an educational adapted aquat-
ics program focuses on teaching individuals with
disabilities how to safely enjoy the aquatic environ-
ment. Since swim strokes, water safety, and other
aquatic skills are paramount, assessment revolves
around determining the individual’s present level
of performance in those areas, focusing either on
curriculum-based needs or on individual skills that
the person can use to function better in her current
or future environment (ecological assessment).
As in the medical-therapeutic model, assessment
begins with a review of medical, educational, and
aquatic records and continues during initial contact
with the participant and during subsequent sessions.
After reviewing this material, you will know the
potential swimmer well enough to begin planning
the aquatic assessment. You should create assessment
forms or select one from appendix D to help you
ascertain present home, school, and medical con-
siderations for the individual. An excellent resource
for aquatic assessment is Assessment of Swimming
in Physical Education by Susan J. Grosse (2005).
This manual contains several aquatic assessment
instruments, including a progress chart for students
with severe disabilities and a Halliwick-Method Skill
Progression Chart.
 Name: ____________________________________________
MR#: __________________________ DOB: _____________
Home phone: ______________________________________
Referring therapist: __________________________________
Date: _____________________________________________
PT extension: _______________________________________

Diagnosis: ______________________________________________________________________________
Precautions: __________________________________________________________________________
Weight-bearing status: Open areas or sutures: ❑ Yes ❑ No
___Non-weight-bearing status: Seizures: ❑ Yes ❑ No
___Toe touch: Other: ____________________________________
___Partial:
___Full:
Contraindicated motions or activities: ________________________________________________________
* Please note: Patients with questionable discharge from open wounds will not be permitted in the pool.
Please check desired activities:
Treatment: Comments and goals:
❑ Balance and coordination _________________________________________
❑ Endurance _________________________________________
❑ Range of motion _________________________________________
❑ Strength _________________________________________
❑ Mobility _________________________________________
❑ Ambulation _________________________________________
❑ Pain management _________________________________________
❑ Transfers _________________________________________
❑ Breath control and lung capacity _________________________________________
❑ Voice projection _________________________________________
❑ Aerobic activity _________________________________________
❑ Tone reduction _________________________________________
❑ Sensory integration _________________________________________
❑ Home program _________________________________________

Insurance approval:
Start and end dates: _______________   Aquatic therapy prescription on file: ❑ Yes ❑ No
# of pool sessions: ________________   Assessment completed by: ______________________________
Signature and date
Form 63012 (03/05) Aquatic Therapy Referral
Courtesy of the duPont Hospital for Children  Wilmington, Delaware

Figure 4.3  The duPont Hospital for Children in Wilmington, Delaware, uses this form as part of the referral process for its
aquatic therapy program.
A.I. duPont Hospital for Children of the Nemours Foundation

73
74 Adapted Aquatics Programming

Curriculum-Based Assessment of their abilities in the water may experience loss

Curriculum-based assessment is founded on the
notion that in order for the individual with disabilities
to succeed in a general swim program or with peers in
recreational swimming, he needs to be able to learn
the skills that his peers use in that setting. Thus, as
the instructor, you should base an assessment on the
skills that you teach to the class that the swimmer
will join, such as the ARC’s progressive swim levels
(1-6) or scuba skills. You can task-analyze these
skills yourself or take them from a source such as the
Special Olympics Aquatics Coaching Guide (www.
specialolympics.org/special+olympics+public+web
site/english/coach/coaching_guides/aquatics/default.
htm). Appendix B contains many valuable assessment
tools as well.
Ecologically Based Assessment
Ecologically based assessments center on what the
swimmer needs to successfully participate in her
current and future environments. These assessments
focus on functional skills and may include skills
tested in a curriculum-based assessment in addition
to skills not addressed in the curriculum. Exiting and
entering the pool area, dressing, appropriately using
language in a swim group, stretching before swim-
ming, knowing how to swim in a circle, using an inner
tube for flotation, and clearing the mouth of water are
examples of prerequisite skills that children without
cognitive disabilities indirectly pick up and so are
rarely taught in a general swim curriculum. But these
are required skills and therefore might be included
in an ecologically based assessment. To assess these
skills, instructors may need to specially design their
own ecologically based assessment tools or combine
various tools such as those in appendix B.
of balance, depth perception difficulty, and lack of
coordination, all of which may cause fear and uncer-
tainty. Water orientation activities that are simple
and fun may break the ice and create an atmosphere
that you can build on for more difficult assessment
tasks. Initial aquatic assessments of young children
with disabilities may be best begun in a wading pool
on the pool deck, in the pool on the gradual ramp
or steps, or on an in-pool water table or bench (see
figure 4.4). In all, the initial assessment in the pool
may not accurately reveal the participant’s present
level of performance. Patience and ongoing assess-
ment in subsequent sessions, however, will better
indicate the individual’s abilities.
If the participant does not show mastery of a skill
during the assessment, you as the aquatics instructor
must analyze that skill performance to determine
what parts of the skill are present and what parts
are missing. To do this, compare the participant’s
performance with a task analysis of the skill. You can
compose your own task analysis by writing down the
simplest components of a skill in the order in which
the participant needs to perform them. See page 75

Conducting Assessments in the

Educational Model
Aquatic assessments can be conducted in a variety of
ways, including an informal observation during free
swim or a more formal observation while working
with the swimmer one on one and making specific
requests. It has been shown that initial formal assess-
ments carried out by a stranger to the child may yield
Photo courtesy of Shawn Stevens

less than top performance. So if you assess a partici-

pant who is not familiar with you, he may hesitate
to perform to his fullest capability. This is especially
true for frightened participants, newly injured swim-
mers, or those who are totally dependent on physical
assistance (e.g., people with quadriplegia).
When meeting the swimmer for the first time in
the water, it is always preferable to include water Figure 4.4  Steps or ramps can provide a secure spot
orientation activities, as individuals who are unsure that allows fearful participants to demonstrate their skills.

for a sample task analysis of the underwater swim as
indicated in the Data-Based Gymnasium instructor’s
skill assessment binder, which is no longer in print.
Although the Data-Based Gymnasium task analyses
are no longer available to access, this example pro-
vides an idea of one task analysis method. Appendix
B contains examples taken from other resources,
including Designing Instructional Swim Programs
for Individuals With Disabilities (Carter, Dolan, &
LeConey, 1994).
Data-Based Gymnasium
Task Analysis
Underwater Swim
Terminal Behavior
Swimming underwater 5 body lengths and
surfacing without choking
Prerequisites
Being able to hold breath underwater for 10
seconds and having the judgment to come
up when air is needed
Short-Term Objectives
Level 1 Submerge full body underwater
while holding instructors’ hands,
twice per session by February 2
Level 2 Submerge full body underwater
and, while under, move into a
horizontal position, with instruc-
tor’s assistance in positioning the
body, by March 9
Level 3 Submerge full body underwater
5 times per session by April 4
Level 4 Submerge full body underwater
and, while under, move into a
horizontal position as if ready for
swimming underwater, by April 9
Level 5 Submerge full body 4 feet (1.2
meters) underwater and, while
under, swim using arms for 10
feet (3.0 meters) and then sur-
face, by May 9
Level 6 Submerge full body underwater
and, while under, swim 15 feet
(4.6 meters) using arms and legs,
by June 9
Level 7 Swim fully underwater for 5 body
lengths by July 9
Individualized Instructional Planning 75
You can develop behavioral objectives for the IEP
or IAPP directly from these task analysis models. The
skill component that the participant achieved is the
present level of performance, and the next component
in the task analysis is the logical short-term objective
and point at which you should begin teaching. For
example, if swimming underwater for 5 body lengths
is the terminal objective and the task analysis for swim-
ming underwater consists of 7 basic components, the
participant who achieves levels 1 and 2 has level 3
as a short-term objective and may have level 7 (the
terminal behavior) as the annual goal.
Recreational Model of Aquatic
Assessment
Observing and interviewing are the most commonly
employed assessment techniques in therapeutic rec-
reation (TR) (Austin & Crawford, 1991). As long as the
observer gives the participant rules to start with, natural
observation of an unstructured recreation swim can
provide valuable information. A TR specialist might use
a video camera, take notes, or use a checklist to help
zero in on specific behaviors while watching the partici-
pant move from the front desk, through the locker and
shower area, and into the pool. A TR specialist might set
up a specific recreation situation in the pool and study
how the participant works within the situation.
In an interview, the participant may complete a
written questionnaire or answer orally. You should
ask about the participant’s aquatic history, leisure
desires and needs, and perceived strengths and
weaknesses.
A TR specialist conducting an adapted aquat-
ics program also uses interviews and observations
to find out more about the participant’s social and
psychological well-being. The interviews uncover
how well the swimmer accepts herself and others,
appreciates her accomplishments, and feels a sense of
belonging to a group and family. A TR specialist also
discerns whether the swimmer has the ability to take
on challenges and if she has self-confidence, leisure
and recreation habits, self-control, self-determination,
self-actualization, appropriate body image, and well-
developed values.
Many organizations that provide TR services
have their own aquatic checklists or inventories, but
you may wish to adapt your own checklist from the
Mirenda Leisure Interest Finder (Mirenda, 1973), the
Self Leisure Interest Profile (McDowell, 1974), or the
Leisure Diagnostic Battery (Witt & Ellis, 1985). Figure
4.5 is an example of a TR aquatic assessment. You may
also wish to include information from task analysis
and swim checklists (see appendix B).
 Therapeutic Recreation Aquatic Assessment

Using Community-Based Aquatic Facilities

Participant’s name: Date of birth:

Date of assessment: Recommended sessions:

Aquatic experience:

Diagnosis and applicable history:

Collaborative team goals:

Client goals:

Take notes on the following areas while observing participant in community-based recreation swim
and swim or exercise class.

Building entry:

Front desk and sign-in procedures:

Toileting:

Pool deck routine:

Pool entry:

In-pool etiquette:

In-class protocol-following:

Independent swim behavior:

Social skills:

Pool exit:

Locker and shower area behavior:

Facility exit:

Figure 4.5  Use this form to help determine the needs and interests of your participant.

76

Transdisciplinary Model of Aquatic
Assessment
As we discussed in chapter 2, a main ingredient in the
transdisciplinary approach is ensuring that all profes-
sionals involved recognize the merit of the others’
disciplines. In other words, you must look beyond
what you have determined as the goals of assessment
and see the big picture through collaboration with
your team members.
The most effective and relevant way to assess is to
have all the professionals who have concerns about
increased motor functioning be present during the
on-land and in-water testing. Observations might
come from different perspectives, but the perspectives
will come from the same picture. The specialist who
will work the most in the water with the participant
should lead the assessment, with others involved if
the participant can handle it. A functional assess-
ment approach, as used in the transdisciplinary
model, involves structured observation during a
typical adapted aquatics session. The observation
should include locker room and toileting behaviors,
transfers and deck movement, interaction with other
participants and staff, entering and exiting the pool,
equipment use, water adjustment, swimming and
recovery, ambulation, balance, and self-propulsion.
Observers may combine assessment tools or use their
own tools as long as all professionals know what the
others are looking for. If some professionals cannot
attend, they should submit specific items that they
would like to see answered by the assessment.
Developing the IEP or IAPP
Developing the aquatics portion of the IEP in a school-
based program or the IAPP in a nonschool program
should also involve a collaborative effort, with pro-
fessionals and swimmers coming together to work
toward common goals through ongoing dialogue
and feedback. If the participant is a child or young
adult (less than 21 years) and aquatics is part of the
educational services, then the goals and objectives
(IAPP) are only part of the IEP. The IDEA mandates
that the IEP be developed in schools by a team that
includes the participant, when appropriate, as well as
parents, teachers, therapists, and a representative of
the local educational agency. Remember, a transdisci-
plinary approach maximizes the participant’s overall
development, gives the team greater problem-solving
abilities, and enables all professionals to use best
teaching practices (see chapter 2) (Block, 2000).
Individualized Instructional Planning 77
In addition to using collaboration in school-based
programs, you can use collaborative teamwork
(Rainforth, York, & Macdonald, 1992) with adults
who participate in your adapted aquatics programs.
An adult not connected with a rehabilitation center
could have a team composed of himself, the aquat-
ics instructor, a significant other, the physician, and
any professional who might significantly contribute
to the team.
As we discussed in chapter 2, each team member
maintains responsibility for a certain focus of skill
development, but the team members cross-train each
other so that they may help carry out each other’s
goals. In the following section, we will discuss how
you can translate assessment information into the
goals and objectives of the IEP or IAPP by using the
transdisciplinary model.
Stating the Present Level of
Performance
You must use the information gathered during the
initial assessment to list strengths and determine
goals. Statements of probability and inference are
not usually a strong basis for developing goals and
objectives. Thus, you should base the statements
that you make about an individual’s present aquatic
performance level on what you and the team have
actually observed. The following is an example of
an accurate statement, made from observations, of a
present level of aquatic performance. This statement
was made after assessing an 18-year-old named Josh
(see figure 4.6):
Josh is an 18-year-old man with hemiplegia cerebral
palsy and average intelligence enrolled in a high
school physical education elective swim class. His
right-side involvement includes slight flexion of the
elbow, wrist, and fingers and adduction of the right
leg. He can enter the pool independently by using the
lift or slowly using the adapted stairs, but he cannot
pull himself out at the poolside and he needs spotting
and an occasional boost when exiting by the stairs.
Josh has difficulty with mouth closure when his face
is submerged and therefore has difficulty blowing
all the air out during rhythmic breathing. He can
perform the front crawl with an underwater recovery
on the right side and an overwater recovery on the
left side. With flotation, he can back glide with kick,
tread water 1 minute, sit dive into the deep end and
surface, survival float for 1 minute, swim underwater
for 15 feet (4.6 meters), and turn to the right while
swimming the modified front crawl.
In addition to motor behaviors, the present level
of performance for your IAPP should include social
78 Adapted Aquatics Programming
Figure 4.6  Josh has tight muscles on his right side, posing challenges to balance and
to performing symmetrical swim strokes.
and emotional behaviors exhibited in the setting in
which the participant may eventually function inde-
pendently. The following paragraph describes these
behaviors for Josh:
Josh cannot independently maneuver through the
locker room or pull up his swimsuit. He is friendly
toward others but tends to speak a bit too loudly and
not stay in his lane while swimming. Josh is unaware
of swim etiquette during recreational swimming and
gets overly embarrassed when confronted with a
new rule. Josh enjoys swimming, but his endurance
is low and he stops often to wipe his face and catch
his breath.
Determining Annual Goals and
Short-Term Objectives
Moving from the present level of performance to
annual goals and short-term objectives is the most
difficult part of planning. Moving from what the
participant can do to what the participant should be
doing takes a great deal of thought, discussion with
others, and finally, decision making. Many factors go
into selecting and prioritizing goals for an individual.
Since specific activities have been targeted in the plan-
ning and assessment phase, the next step is to develop
a list of skills that the participant appears to need as
revealed by the assessment. These skills should be
listed as needs and then logically sequenced to pro-
vide a template for the goals and objectives to come.
This list is the needs list, which must be prioritized as
suggested in the next section (Setting Priorities). Let’s
return to the previous example of Josh. His needs list
might resemble the following:
Improve breath control skills
Improve range of motion during strokes
Develop strokes on back
Develop skills for long-distance swimming
Increase endurance during treading water and
lap swim
Improve overall body coordination
Develop swim etiquette and awareness of rec-
reational skills
Develop pool exit skills for the diving well area
Setting Priorities
To help you prioritize the needs list, we have adapted
the checklist from “A Systematic Procedure for Pri-
oritizing IEP Goals” (Dardig & Heward, 1981) for
you to use as an example (see figure 4.7). Write
each task or activity at the top of a blank checklist
and evaluate each against the 17 statements. Add the
numbers, and then target the activities or tasks with
the highest totals.
Determining Logical Sequence
Once you prioritize activities, you can sequence those
skills that are prerequisites to one another, deter-
mining in what order the participant might be able
to accomplish the skills. Look for skills that would
logically precede others or build on a previous skill.
For example, Josh needs to develop skills for long-
distance swimming but also needs to develop overall
endurance in addition to learning swim strokes on the
back. The rational sequence is to have Josh work on
swim strokes on his back as a possible prerequisite to
 Individualized Instructional Planning 79

Checklist for Prioritizing Goals

0 = strongly disagree; 1 = somewhat disagree; 2 = somewhat agree; 3 = strongly agree

_____ 1. Participant can use task in current environments.

_____ 2. Participant can use task in future environments.
_____ 3. Activity provides opportunity for socialization.
_____ 4. Task prepares participant for a greater goal.
_____ 5. Task is age appropriate.
_____ 6. Task fosters independence.
_____ 7. Task fosters another goal from another discipline.
_____ 8. Task meets a medical need.
_____ 9. Participant rates task as a high priority.
_____ 10. Significant other or caregiver rates task as a high priority.
_____ 11. Task promotes a positive view of the individual.
_____ 12. Individual has access to this activity after the program ends.
_____ 13. Task improves fitness and wellness.
_____ 14. Participant can engage in activity alone or with family and friends.
_____ 15. Related service professionals support task or activity.
_____ 16. Equipment is available for task.
_____ 17. Facilities are available and accessible for activity.

Figure 4.7  Use this checklist to rate each potential activity in order to determine which to target.
© 1981 School Study Council of Ohio. Adapted with permission of publisher.

developing skills for long-distance swimming while at
the same time having him work on improved breath
control for prone swimming.
When determining logical sequence, another
concept might come into play, and that is how
many skills you should try to develop. Deciding on
how many skills you can teach depends on factors
such as the group size, the teacher-to-student ratio,
the support staff needed, the equipment available,
the time of day, the instructional time per week, the
instructor experience, the participant ability, and the
pool and air temperatures. In addition, participant
fitness level, medications, developmental readiness,
and other considerations will play a role. Don’t fall
into the common trap of trying to teach too many
skills, exposing the participant to so many that he
cannot master any. Indeed, it might be reasonable
to choose only 5 skills to master in 1 year for a par-
ticipant who attends instructional adapted aquatics
class for 45 minutes once a week in a group of 5
other participants. In the case of Josh, the instructor
would look at the priority list and realize that working
on swim skills on the back could improve range of
motion, if planned for, and also develop endurance
and skills for long-distance swimming. There is no
reason why Josh cannot simultaneously work on
swim etiquette while practicing his swim skills on
his back! Instead of trying to develop several objec-
tives for each of the participant’s needs, the swim
instructor should collaborate with the team, decide
on specifics such as how to accomplish the team’s
goals within the aquatic venue, and then prioritize
which skills might be the target of the annual goals.
Table 4.2 provides an example of how to calculate
instructional time so that you can decide how many
objectives to plan for.
80 Adapted Aquatics Programming
Table 4.2
Estimated Calculation of Instructional Time
1. Number of weeks in aquatics session
2. Days per week of aquatics class
3. Total number of days per session (multiply items 1 and 2)
4. Number of minutes of instruction per class
5. Total number of minutes of class instruction for the session (multiply items 3 and 4)
6. Estimated lost instructional time for sickness, weather, and so on (10% of item 5, or 0.10 3 1,000)
7. Total time available for instruction
900 ÷ 60 = 15 hr available for instruction, about enough time for a student to master one objective.
Writing Goals and Objectives
Once you and the team prioritize and sequence the
goals, write them as broad but measurable statements,
grouping compatible objectives into categories that
have common instructional relevance.
The goals for Josh might include the following: (a)
to demonstrate increased endurance, (b) to perform
pool entries and exits more safely, and (c) to swim
with improved propulsion. For each goal statement
you should be able to explain the intent behind
the goal, the purpose of reaching for that goal, and
the significance or motivation for the participant to
achieve the goal (Davis, 1989).
Once you have written long-term goals as broad
but measurable statements, write more specific skill
objectives with criteria for what the participant needs
to achieve under each goal. For example, the goal
“Josh will improve breath control by increasing the
number of consecutive rhythmic breathing cycles” will
be linked to a relevant short-term performance (skill)
objective, such as “Josh will perform 10 continuous
rhythmic breathing cycles during the breast stroke,
in 3 of 4 trials, for 2 consecutive aquatics classes.”
Consider this 1-year goal: “Josh will improve endur-
ance by June of next year as shown by continuously
swimming for 12 minutes.” Write an objective (or
several objectives) for that goal by using the assess-
ment results of one of the priority tasks in that category.
This objective should be even more measurable and
observable and should include a short-term date. For
example, “Josh will improve endurance as shown by
swimming continuously for 2 minutes, 2 aquatic ses-
sions in a row, by the end of March 2008.”
Working backward from the target (terminal or
end-point) behavior, use your experience and what
10 wk
2 day/wk
20 day
50 min
1,000 min
100 min
900 min
you know about the participant to determine the
projected time, equipment, and support needed
to teach the skill. Answer the following questions
when deciding on the time, support, and equipment
needed: How many others are in the swim group?
Does Josh follow directions accurately? What other
distractions might be in the pool during Josh’s swim
time? Is there an instructional assistant? How deep is
the water Josh will be working in? At what time of day
is this lesson in Josh’s school schedule? How much
actual time does Josh have in the water since it takes
him 25 minutes to change with assistance at the end
of the lesson and 15 minutes to get ready before the
lesson begins?
Even if you are on the money with your objectives,
and Josh has 45 minutes of actual water time once
a week in a group of 5 other students, it might take
you 3 to 4 months to achieve one of your short-term
objectives. When you are writing objectives for the
year, you must estimate that it may take from 10 to
12 hours (3-4 months) of instruction to achieve an
objective. When teaching swimmers with cognitive
disabilities or severe multiple disabilities, it may take
twice that time.
You may need to further analyze a goal that takes
too long to achieve. Consider breaking tasks that
will take longer than 10 to 12 hours of instruction
into smaller time frames, perhaps setting goals that
will take as little as 4 or 5 hours to achieve. It takes
practice to judge the time it takes a participant to
progress, so be flexible and learn from your mistakes.
For example, if after several months of swim instruc-
tion, Josh is not near the objective of swimming on
his back for 2 continuous minutes, you may want to
shorten that objective to swimming on the back for
30 seconds or add flotation devices to the mix.

In addition to stating a time interval, objectives
should identify the action the participant will perform,
the criteria (quantity and quality of performance) by
which you will deem the skill acceptable, and the
conditions under which the performance will take
place. Use an action verb to make the statement
observable, such as swim, perform, demonstrate, or
participate. The criteria are statements of accuracy
that specify how well, how fast, how deep, or how
many times the participant must perform the action
with acceptable quality. The conditions are the envi-
ronmental surroundings and cues that help define
how the participant performs the action, such as “in
the diving well,” “with a kickboard,” “with a verbal
prompt,” or “during a general swim class.” The fol-
lowing are examples of well-written performance
objectives:
• Josh will show improved breath control by
August 8 as demonstrated by bobbing in the
diving well 20 consecutive times for 2 consecu-
tive swim sessions.
• Josh will show improved endurance and deep
water skills by June 13 as demonstrated by
treading water that is 9 feet (2.7 meters) deep
for 3 minutes, for 2 out of 3 swim sessions.
• Josh will show improved swim skills on his back
and increased endurance and body coordina-
tion by January 20 as demonstrated by perform-
ing a back glide off the pool wall, then a stroke
on the back for 30 seconds, without choking
on water, for 3 out of 4 sessions.
• Josh will show improved exiting skills by April
28 as demonstrated by pulling himself onto
the first rung of the ladder and holding that
position for 5 seconds for 2 out of 3 trials per
swim session.
• Josh will show improved swim etiquette and
leisure skills by May 1 by correctly positioning
himself in an uncrowded lane and circle swim-
ming or walking for 2 out of 3 sessions.
• Josh will show improved range of motion by
June 1 by performing the front crawl with body
rotation and recovery with the left arm out of
water on 1 of every 20 attempts, 3 times per
session.
Additional Components of the
Individual Plan
In addition to including the present level of perfor-
mance, annual goals, short-term objectives, and
starting and ending dates for the program, the IEP or
Individualized Instructional Planning 81
IAPP should state the specific aquatics services that
the participant will receive, including any special
instructional materials and the learning, physical, or
emotional support the participant needs to participate
in aquatics. Moreover, a plan is not complete without
referring to how the disability affects the progress
of the swimmer in the general aquatics curriculum,
stating how the person will be evaluated and when
and how the parents or caregivers will be given
progress reports, and describing how the swimmer
participates in the general curriculum. The extent to
which the individual will participate in general aquat-
ics programs and a justification for the individual’s
placement (see chapter 3) are important points in the
individual plan. A final section might describe how
the skills projected for mastery will help the individual
succeed in leisure, work, play, school, or home pur-
suits and improve her quality of life. If the program
is school based and therefore one section of the IEP,
this section must be presented to the parents and
transdisciplinary team and be signed by all involved
as an agreement on what will be provided, how it will
be provided, and how long it will be provided. If the
program occurs outside of school, the people who
care for and about the swimmer should be involved in
this final decision on what will be learned. If nothing
else, the swimmer himself should collaborate with
the aquatics instructor.
Implementing the IEP or IAPP
So now you have a plan for what the student will try
to achieve and what you will attempt to teach. When
implementing this plan, you will need to look at the
swimmer’s learning environment. You’ll have the most
success implementing an individual plan when (a) the
class has a low participant-to-instructor ratio or the
participant has a one-on-one instructional situation
with the adapted aquatics instructor, (b) the individ-
ual’s goals somewhat match with the goals of the
inclusive or group class, and (c) the participant with
the individual plan has another instructor or instructor
assistant with her in the pool. The sidebar on page
82 gives hints for successfully working on individual
goals and objectives within a group setting.
Implementing individual goals within a group
setting has a higher chance of success when a
thorough lesson plan is prepared. Lesson planning
involves looking at the individual’s present level of
performance and projected goals and objectives, the
group’s goals and objectives, and the ways in which
you can bridge the gap or mesh the two. Refer to
chapter 3 for more information about successfully
82 Adapted Aquatics Programming

Hints for Achieving Individual Goals

in a Group Setting
❚ Target the behavior you want to see and ❚ Analyze activities to ensure that each
communicate it to the participant and the participant has the prerequisite cognitive,
assistant or other instructors. social, and physical skills needed to partici-
❚ Divide your activities into subcomponents pate in an activity; if not, provide support.
so that during an activity all participants in ❚ Use laminated task cards with instructions
the group can work on different phases of or pictures for tasks that can be practiced
the same task. alone or with minimal intervention (see
figure 4.8).
❚ Provide activities with skill competency and
difficulty levels that can be modified so that
individuals with different goals can perform
the activities together.
❚ Know each participant’s goals and objec-
tives so you do not have to spend instruc-
tional time on deck referring to your lesson
plan or to participants’ individual plans.
❚ In your lesson plan, list objectives for the
group as well as for individuals, in order to
have them handy.
❚ Pair students with similar goals during activi-
ties.
❚ Provide specific feedback to each swim-
mer based on the specific components of
the skill the individual is working on.
❚ Use station teaching, having participants
go only to the stations at which they need
to work.
❚ Change distances, movements, speeds,
and equipment to individualize the goal
for each participant.
❚ Modify rules, expectations, and require-
ments to meet individual capacities.
❚ Adapt your communication mode, teach- Figure 4.8  Laminated task cards serve as motivation
ing method, and amount of feedback to for swimmers to stay on task as they work toward their
meet individual needs. goals.

including individuals with disabilities in aquatics
programs.
How you organize your lessons is pivotal to suc-
cess. Lesson planning includes preparing your mate-
rials and conceiving a strategy to facilitate learning.
A complete lesson plan states goals and objectives
compatible with individual program plans, describes
specific activities you have determined will help meet
the goals and objectives, and outlines a timetable
for moving from activity to activity. Incorporate
individual goals into group goals if they match
and plan adaptations when the IEP or IAPP and
the group lesson do not match. When goals do
not match, use an adapted aquatics specialist as
a coteacher, a peer tutor, or an assistant. Refer to
the sidebar on page 83 for a handy checklist that
will help you prepare lesson plans or evaluate
colleagues’ plans.
 Individualized Instructional Planning 83

Lesson Plan Evaluation Summary

❚ Are goals and objectives compatible
with individual program plans?
❚ Do performance objectives describe
learner behavior, not teacher behavior?
❚ Do performance objectives contain
conditions, observable behaviors, and
criteria?
❚ Do performance objectives reflect func-
tional behaviors?
❚ Are the activities age appropriate?
❚ Are the activities developmentally
appropriate?
❚ Does the plan include how a group
member will participate in an activity
if the individual goal differs from the
primary goal of the activity?
❚ Does the plan include progressions or
task analysis?
❚ Does the plan include specific inter-
ventions for affective and cognitive
learning?
❚ Does the plan include how the students
and teacher will use equipment?
❚ Does the plan include methods for
varied practice?
❚ Does the plan include strategies for
intervention and feedback?
❚ Does the plan include assessment activi-
ties that will let the teacher know when
students have achieved objectives?
Follow the guidelines in this chapter on your jour-
ney from assessing and planning for participants to
developing and implementing the aquatics portion
of the IEP or IAPP. Remember to keep overall age-
appropriate goals as well as individual needs in mind
when planning for and assessing individuals with
disabilities. Ensure that the needs of the individual
drive the assessment, objectives, and activities. Base
placement on the health, wellness, and educational
needs of the individual; the desires of the individual
and family; and the functional skills that the individual
needs to participate in present and future settings.
Although time consuming, the IEP or IAPP is the
key to a personalized curriculum. The IEP and IAPP
signify the collaboration and agreement of instructor,
participant, parents or caregivers, significant others,
and other professionals as to the appropriate course
of action. The tasks and activities you choose for the
participant to practice should flow directly from the
IEP or IAPP. Lesson plans help to make the transition
from objectives to skill acquisition.
The IEP or IAPP and the lesson plans that flow from
it create the vision that will help individuals with
disabilities move from point A to point B. Indeed,
a well-written IAPP facilitates that vision, conveys
it to others, and helps you implement effective and
relevant programs.

Chapter 4
Review 1. Since accommodating individuals with disabilities begins with assessment,
what should you do before performing an aquatic assessment of individu-
als with disabilities?
2. Why must aquatic assessment take place before aquatics participation?
3. Explain why instruction and ongoing assessment are synonymous.
4. What factors influence the number of skills a participant can learn during
a year?
5. What are the components of a properly stated objective?
6. What are some hints for achieving individual goals within a group aquat-
ics class?
7. What are some questions you might ask yourself to determine if a lesson
plan is all inclusive and well thought out?
This page intentionally left blank.
 5
Program and
Organization
Development

A   swimming instructor at a local community center started an adapted

aquatics program in response to a small group of parents who had pas-
sionately persevered in their effort to find swimming lessons for their children.
Initially the program served 10 children with various disabilities and met 1 hour a
week. After 4 months, the swimming instructor added another weekly session to
accommodate 12 more children. After 6 months, the instructor had a waiting list
that included 20 more children. In order to have sufficient instructors, parents and
other volunteers were recruited and trained to assist with swimming lessons.
The executive director of the community center became increasingly aware
of the additional resources needed to maintain the program. However, the com-
munity need was great, parental support was high, and everyone involved was
committed to maintaining the program. More time was spent recruiting, training,
and organizing volunteers. Instructional equipment was needed, so grants were
solicited from local companies and foundations. Parents started to organize and
discuss other issues regarding services for their children. Scheduling with facilities
became increasingly difficult as other courses and community groups competed
for pool time. Plans were also made to develop a 2-week summer camp and to
further expand the current program in the coming year.
(continued)

85
86 Adapted Aquatics Programming

What started out as a simple adapted aquatics class was evolving into complex
processes and activities aimed at achieving goals for a broader mission. The pro-
gram affected the organizational operations of the community center, including
human resource development, marketing, strategic planning, budgeting, fund-
ing, and equipment and facility acquisition. This scenario is an example of what
happens when programs are successful and community need is great. However,
continued success requires the ability to effectively and efficiently develop the
organization.

I mplementing successful adapted aquatics programs

requires more than good intentions and quality
instruction. As a program expands and takes on the
delivered focuses strategic planning and
successful program implementation.

characteristics of an organization, or as flourishing

programs become more integrated in an organiza-
tion, program planning becomes more complex and
comprehensive. Effective organizational development
cultivates community support, ensures the acquisition
of appropriate resources, enhances and expands pro-
gram development, and secures a leadership structure
for maintaining the organization.
Well-managed administration, which is funda-
mental to a successful adapted aquatics program,
includes several elements. Effective staff develop-
ment ensures that a sufficient number of qualified
staff is available to maintain and improve programs.
Effective management of human resources positively
affects the quality and continuity of program delivery.
Appropriate funding and facilities are basic to pro-
gram survival. Community support developed through
networking and collaboration enhances program
success and sustainability. Adherence to guidelines
for risk management creates a safe environment for
service delivery and limits exposure to expensive legal
actions. Appropriate communication with the public,
advocacy agencies, community leaders, media, other
aquatics professionals, and program constituents
contributes to the development and support of the
adapted aquatics program. This chapter gives a brief
overview of each of these components of organization
and program development.
Chapter Objectives
From this chapter, you will learn the
following:
* Understanding the structure of the orga-
nization through which a program is
* Effectively communicating and promot-
ing program features helps to success-
fully develop and sustain the adapted
aquatics program.
* Adapted aquatics programs may be
sustained through a variety of financial
developments or funding resources.
* Appropriate facilities for adapted
aquatics programs may be acquired
through many for-profit and not-for-profit
community organizations.
* Program leaders and staff must employ
risk management to ensure safety.
* A structured approach to program
development and evaluation is basic to
ensuring program and participant suc-
cess.
* A foundation of successful program
delivery is a human resources manage-
ment system that provides competent
paid or volunteer staff.
Organizational Foundations
Several organizational building blocks facilitate an
organization’s long-term survival. A realistic and
visionary strategic plan guides the organization to
continued success. Appropriate funding, facilities,
and resources provide the means for sustaining pro-
grams. Effective governance, leadership, community
support, program development, and risk management
carry the organization through growth and conflict.
 Program and Organization Development 87

Strategic Planning seeking new funding resources. Although many

A strategic plan can successfully guide an organi-
zation as its adapted aquatics programs evolve by
providing sufficient structure to keep the organization
on track over the next 3 to 5 years. An effective stra-
tegic plan is also flexible, allowing the organization
to adapt to new conditions that might result from
serving a diverse population, meeting legislative
mandates, establishing staff and facility needs, and
management models for developing a strategic plan
exist, the components depicted in figure 5.1 form a
basic template for creating the plan.
External and Internal Issues
A strategic assessment includes an environmental
analysis of external and internal issues that directly
influence the organization and its programs. External

Strategic assessment = environmental analysis of

Internal External
issues and trends that influence the organization.

Mission = statement of the organization’s purpose,

reason for existence, and unique characteristics.

Vision = statement reflecting the future direction of the

organization.

Principles = statements indicating philosophical

guidelines and values for organizational activities.

Goal 1 Goal 2 Goal 3

Goals = statements that translate the mission into major policy directives.

Strategic Strategic Strategic

objectives objectives objectives

Strategic objectives = major accomplishments for a defined length of time.

Operational and program plans = objectives and action steps for

1 year of the strategic plan.

Figure 5.1  A strategic planning model. E3344/Lepore/fig.5.1/278220/alw/r2

88 Adapted Aquatics Programming
issues might include legislation (e.g., ADA) that affects
services and funding for individuals with disabilities,
access to aquatics facilities in the community,
advocacy from the professional community for
inclusion programs, and community support for
programs serving individuals with disabilities. Internal
issues might include leadership support for adapted
aquatics programs, intraorganizational competition
among different departments for program resources,
and awareness among organizational staff regarding
the needs of individuals with disabilities. An initial
step in strategic planning is to list the internal and
external issues specific to your organization as a way
of determining what realistic plans your organization
might develop. You may proceed with a SWOT
analysis, which assesses organizational strengths (S)
and weaknesses (W) in confronting issues identified
as opportunities (O) or threats (T) to organizational
success (Wilbur, Finn, & Freeland, 1994).
Describing an Organization
Why does the organization exist? What will it become
over time? What does it stand for? What makes it
unique? The answers to these questions are requisites
if a community is to view an organization as cred-
ible, useful, and desirable. Generally, such answers
are articulated through statements describing the
organization’s mission, vision, and principles.
The mission is a clear and concise statement
describing the organization’s purpose, philosophy,
uniqueness, and reason for existence. Such a state-
ment reflects the credibility and recognition of the
organization and how it positions itself compared
to other organizations. The missions of the following
organizations provide some varied examples.
YMCA: To put Christian principles in practice
through programs that build healthy spirit,
mind, and body for all. (www.ymca.net)
Special Olympics: To provide year-round
sports training and athletic competition in a
variety of Olympic-type sports for children and
adults with intellectual disabilities, giving them
continuing opportunities to develop physical
fitness, demonstrate courage, experience joy
and participate in a sharing of gifts, skills and
friendship with their families, other Special
Olympics athletes and the community. (www.
specialolympics.org)
United Cerebral Palsy: To advance the inde-
pendence, productivity, and full citizenship
of people with disabilities through an affiliate
network. (www.ucp.org)
ARC: A humanitarian organization led by volun-
teers, guided by its Congressional Charter and
the Fundamental Principles of the International
Red Cross Movement, will provide relief to
victims of disasters and help people prevent,
prepare for, and respond to emergencies. (www.
redcross.org)
Due to the comprehensive service delivery of these
organizations, their mission statements encompass
but do not specifically identify aquatics programs. The
mission statement for our fictional model organiza-
tion, Aqu-Achievements (see figure 5.2), is a sample
statement specific to an aquatics organization.
An organization’s vision establishes where it plans
to be at some future point. It reflects how the organi-
zation wants to be viewed by its customers, members,
and community. Accordingly, Aqu-Achievements’
vision requires committing its resources to strive con-
tinually for this vision. Special Olympics expresses
its vision passionately and comprehensively as fol-
lows:
Special Olympics is an unprecedented global move-
ment which, through quality sports training and
competition, improves the lives of people with intel-
lectual disabilities and, in turn, the lives of everyone
they touch.
• Special Olympics empowers people with intel-
lectual disabilities to realize their full potential
and develop their skills through year-round
sports training and competition.
• As a result, Special Olympics athletes become
fulfilled and productive members of their fami-
lies and the communities in which they live.
• Special Olympics is an experience that is
energizing, healthy, skillful, welcoming and
joyful. (www.specialolympics.org)
An organization is composed of people whose col-
lective principles provide a foundation for directing
policy decisions, initiatives, and programming. Clearly
identifying these principles permits the organization’s
leaders, paid staff members, volunteers, and support-
ers to better understand and embrace the governance
and direction of the organization. Figure 5.2 includes
example principles for Aqu-Achievements. A com-
mitment to principles can make it easier for leaders
to decide how to implement programs, recruit staff,
allocate funds, and advocate for clients. Articulating
the principles enables the community to understand
the passion and motivation of the organization’s
stakeholders. Special Olympics reveals its passion
through its 11 documented principles, 2 of which
follow on page 90 as examples for you.
 Aqu-Achievements
Strategic assessment
Internal environmental issues and trends
Modern aquatic facility with complete accessibility
Segregated programs emphasizing physical and skill development
Resources for staff recruitment and training
Budget to support program development
External environmental issues and trends
Specific legislation supporting programs for individuals with disabilities
Climate supporting advocacy and inclusion programs
Competition for corporate and foundation funding
Mission
Aqu-Achievements provides individuals with dis-
abilities opportunities for personal challenge, self-
confidence, fitness, socialization, lifestyle enrich-
ment, and development of physical, motor, and
safety skills through educational, recreational,
competitive, and therapeutic aquatics programs.
Vision
Aqu-Achievements will provide the most accessible,
available, and comprehensive aquatics programs for
any individuals with disabilities desiring to partici-
pate in aquatic activities.
Principles
• Programs that provide increased opportunities
for physical, personal, and social development
should be made available and accessible to
individuals with disabilities.
• Aqu-Achievements supports community efforts
to increase public awareness about disabilities
and to increase opportunities for individuals
with disabilities to participate equitably as
members of the community.
• Aqu-Achievements promotes the inclusion of
individuals with disabilities in its organiza-
tional governance, staffing, and program devel-
opment.
Figure 5.2  A sample strategic plan.
Strength Opportunity
or Weakness or Threat
Goals and strategic objectives
Program development—Increase the types of aquat-
ics programs available to individuals with disabilities.
• Initiate three competitive swimming programs
targeted to specific individuals with disabilities.
• Implement an inclusive aquatics program that
provides educational and recreational aquatic
activities for children with disabilities and their
typically developing siblings.
• Develop and implement a year-round thera-
peutic aquatics program.
Facility development—Implement facility modifi-
cations to improve accessibility and attract a more
diverse population of individuals with disabilities.
• Build new male and female locker room facili-
ties at ground level and adjacent to the pool to
provide improved accessibility.
• Build a ramp extending into the shallow end of
the pool so as not to depend on the hydraulic
lift for entry and exit.
Human resource development—Provide opportuni-
ties for individuals with disabilities to serve the orga-
nization in paid staff and leadership positions.
• Ensure a significant representation (at least
25%) of individuals with disabilities serving
on the board of directors and other leadership
committees.
• Promote paid staff positions to ensure that indi-
viduals with disabilities are recruited as appli-
cants prior to interviews and selection.
89
90 Adapted Aquatics Programming
To provide the most enjoyable, beneficial and
challenging activities for athletes with intellectual
disabilities, Special Olympics operates worldwide
in accordance with the following principles and
beliefs:
• That the goal of Special Olympics is to help
bring all persons with intellectual disabili-
ties into the larger society under conditions
whereby they are accepted, respected and given
a chance to become productive citizens.
• That, as a means of achieving this goal, Special
Olympics encourages its more capable ath-
letes to move from Special Olympics training
and competition into school and community
programs where they can compete in regular
sports activities. The decision to leave or to
continue involvement in Special Olympics is
the athlete’s choice. (www.specialolympics.
org)
Goals and Strategic Objectives
Organizational goals refine the organization’s mis-
sion by stating policy directives. Such goals guide
all subsequent management decisions regarding
the resources and activities needed to achieve the
mission. Goals promote continuity and stability by
keeping the organizational leadership focused. In
contrast, an organization not guided by its goals
might simply react to environmental conditions and
the whims of organizational constituents, thereby
derailing its own efforts to serve. Ultimately, goals
articulate opportunities for proactively achieving the
organization’s mission and establishing an image that
promotes credibility, support, and confidence.
Developing goals involves translating the orga-
nization’s mission into a limited number of broad
statements that focus on ways to achieve the mission.
Goal statements are useful if they meet the following
criteria:
• They clarify the mission.
• They specify major organizational purposes.
• They provide a basis for developing program
activities and operational plans.
• They provide a basis for determining organi-
zational priorities (Wilbur, Finn, & Freeland,
1994).
The three sample goals for Aqu-Achievements (see
figure 5.2) provide examples of how your organiza-
tion might write goals.
After developing goals, organizational leaders must
define the strategic objectives that will become the
major accomplishments for a given length of time.
These strategic objectives help provide a concrete
measurement of whether or not the organization is
succeeding in its mission. Such strategies might focus
on diversifying services, developing collaborative pro-
grams with other organizations, developing new and
improved resources to enhance programs, or attracting
more customers. The sample strategic objectives for
Aqu-Achievements (see figure 5.2) demonstrate how
strategic objectives evolve from goals and how they
quantify or qualify the broader goal statement. The
Aqu-Achievements strategic plan serves as a model
to show how an organization might define and write
strategies, which in turn further clarify how the orga-
nization should allocate resources, assess accomplish-
ments, and plan activities for the fiscal year.
Once complete, the strategic plan guides the
activities of the organization, including resource
allocation, budgeting, financial development, market-
ing, and service delivery. Staff may further refine the
strategic plan by developing a short-term operational
plan that identifies the objectives and actions that the
organization will accomplish over the next operat-
ing or fiscal year. Generally, the time period for the
operational plan conforms to a budget cycle, making
it much easier to monitor and facilitate achievement
of the strategic plan.
Each objective and action an organization includes
in its operational plan should be a concrete and
measurable step intended to achieve the strategic
objectives and goals of the strategic plan. Finally,
the organization should establish its annual budget
based on its operational plan. Although organization
leaders may compile information from many sources
to develop strategic and operational plans, ultimately
they should agree that the plan is sufficiently com-
plete, comprehensive, and achievable and that appro-
priate organizational resources are available.
Governance and Leadership
Some adapted aquatics programs operate on a for-
profit basis. More typical are those programs that
are provided through not-for-profit organizations.
Many of these organizations carry the U.S. Internal
Revenue Service status of 501(c)(3) and thus are
subject to federal rules of governance and financial
management and are guided by set laws, policies,
and procedures.
A common practice of a nonprofit, community-
based organization is to create a board of directors
to govern the organization. Its officers and directors
establish policies and supervise the fiscal manage-
ment of the organization. Directors tend to represent
specific interests that can support the success of
the organization through their influence, affluence,
public profile, or expertise.

A board of directors of an organization providing
adapted aquatics programs benefits from including
individuals with disabilities among its representatives.
Such a practice demonstrates support of the organi-
zation’s mission, lends credibility to its programs,
provides expertise useful to policy and program
development, and ensures appropriate sensitivity
to customers served by the organization. The board
might improve its effectiveness by supplementing
its membership with committee structures, advisory
boards, paid and volunteer staff, and other leadership
volunteers.
Communications and
Promotion
Effectively communicating and promoting the pur-
poses, contents, and outcomes of adapted aquatics
programs will help sustain and develop these pro-
grams. Chapters 2, 6, and 7 describe the reasons for
communicating with other aquatics professionals, the
importance of cross-disciplinary communication, and
the appropriate methods for sharing information. Here
we’ll examine the value of communicating about and
promoting your organization. By doing so, you can
provide additional opportunities to increase program
participation, funding, community support, staff
recruitment, and customer satisfaction. In general, it
is best to direct these communication and promotion
efforts through external communications with the
public, media, and other organizations and through
internal communications with program customers
and constituents.
External Communications
Any opportunity that presents a positive image of
your organization and its programs enhances public
awareness and establishes a foundation for future
support. You can be certain that modesty does not
build identity or recognition! Encourage program par-
ticipants, volunteers, leaders, and paid staff to tell the
organization’s story. Actively solicit opportunities to
relate the mission and vision of the organization and
its value to the community. Seek to gain organization
and program recognition through speaking engage-
ments with schools, civic groups, funding groups,
professional groups, support and advocacy groups,
and employee groups. Apply for community and
professional awards. Participate in community events
such as fairs and conferences. Regularly communi-
cate with business and industry leaders, state and
government officials, and other community leaders.
Program and Organization Development 91
Encourage such leaders to speak on the organization’s
behalf. Develop and distribute publications, such as
brochures, newsletters, and annual reports. The effort
expended to raise public awareness can significantly
pay off by obtaining financial, human, and material
resources for program development.
One way organizations increase public awareness
is through interaction with the media. Accordingly,
your organization might find effective ways to engage
the media and develop its media relations. Consider
asking people involved in the local media to serve
on advisory committees or on the board of directors.
Developing personal contacts within the media could
increase the possibilities of placing news releases or
public service announcements (PSAs) or securing
feature articles and radio spots.
Interagency Communications and
Advocacy
Coalitions and councils have become common,
formal ways for developing interagency communi-
cation. People within your organization, however,
may build informal networks by communicating with
peers and colleagues in other organizations. You can
compile information in news releases, newsletters,
reports, and brochures and routinely distribute these
materials via mail, fax, e-mail, and Internet bulletin
boards and chat groups.
Communication among organizations with related
missions, programs, operations, and customers can
achieve several objectives:
• Organizations can promote each other’s pro-
grams, providing more ways to recruit and serve
customers.
• Organizations can share staff with specific
managerial, functional, or technical skills.
• Organizations can build advocacy for programs
and services affecting a target population.
• Organizations can collaborate to solve common
problems and service delivery issues.
• Organizations can partner to increase opportu-
nities for obtaining foundation, government, or
corporate grants.
Communication With Customers
and Constituents
The survival of any program certainly requires the
support of its customers and constituents. Custom-
ers include individuals who directly participate in
the adapted aquatics program and individuals who
are indirectly affected by the program, such as the
92 Adapted Aquatics Programming
parents, relatives, friends, and caregivers of the par-
ticipants. Constituents include all individuals and
groups who support or associate with the adapted
aquatics program, such as parent support groups,
funding sources, volunteers, and referral sources.
Since customers and constituents are highly motivated
and involved with the adapted aquatics program, they
are in the best position to promote it. An organization
can influence the way its customers and constituents
promote its programs by providing targeted, quality
communications. Newsletters, brochures, and other
internal communications should educate customers
and constituents about the purposes, contents, fea-
tures, and benefits of the adapted aquatics program so
that they can then provide appropriate word-of-mouth
promotion. Informal and formal program orientations
and recognitions provide another opportunity to
excite individuals about the program and encourage
them to tell the program’s good news.
Community Support
The patronage of key community leaders and groups
who have influence, affluence, or expertise can sus-
tain your organization, help it grow, and spread its
recognition and credibility throughout the commu-
nity, giving it the competitive edge in gaining com-
munity support. To elicit community support, your
organization must tailor its statements of objectives
to show others how they may positively affect your
programs. Consider, for example, how an organiza-
tion such as Aqu-Achievements might cultivate suf-
ficient and appropriate community support in order
to achieve the following organizational objectives:
• Aqu-Achievements wants to submit a state
grant-in-aid application for $20,000 U.S. to expand
its adapted aquatics program in the next fiscal year.
The competition for these funds mandates that Aqu-
Achievements gain the support of several key legisla-
tors. Aqu-Achievements must also rally the support
of influential customers, corporate leaders, agency
heads, advocacy groups, and parent groups to lobby
on its behalf.
• During the next year, Aqu-Achievements wants
to provide four satellite adapted aquatics programs in
a two-county region. The programs will be delivered
year-round, so pools must be secured accordingly.
Volunteers are needed to solicit other organizations
for pool time, preferably as an in-kind donation.
• Aqu-Achievements is planning a capital cam-
paign for funding a state-of-the-art, outdoor aquatics
facility. The campaign for $2 million U.S. will require
solicitation of corporate and foundation grants and
major gifts. The steering committee and solicitors
leading the campaign must cultivate major givers in
the regional area.
• Over the next 2 years, Aqu-Achievements wants
to position itself as a leader in providing therapeutic
aquatics programs that supplement medical care
and physical therapy. Aqu-Achievements expects to
partially recover program costs through the clients’
insurance carriers. The advice, expertise, and influ-
ence of clients, members of the medical community,
and allied health professionals will be instrumental in
developing and implementing this program.
Note the specificity of each objective. This specific-
ity permits potential supporters to understand their
roles in helping the organization and reveals any
personal benefits of their sponsorship. If the objectives
are clearly understood and the support is sufficient
and successful, the organization will greatly increase
its ability to achieve desired results.
Achieving each objective requires more than the
efforts of paid and volunteer staff committed to an
adapted aquatics program. For example, competition
for resources can occur internally among departments
and programs within an organization and externally
among community organizations trying to maintain
and expand their own programs. Your organization
can confront such competition by developing com-
munity support through increased recognition of
the existence and the value of its programs, thereby
increasing participation in those programs.
Financial Development
Equipment, facilities, materials, personnel, and
administrative expenses are only a few of the many
costs associated with providing aquatics programs.
Funding sources and ways to secure funding are
limited only by the initiative, creativity, and drive of
the people seeking the funding. In any geographic
area, hundreds, even thousands, of nonprofit and
charitable organizations compete for funds to support
their programs. When securing funding, it may not be
a matter of who has the most worthwhile programs
as much as a matter of who is the most organized in
soliciting funds.
Revenue Generation
Perhaps the most tangible way to obtain program
funds is through charging membership and program
fees. Many organizations, such as YMCAs, Boys and
Girls Clubs, and Jewish Community Centers, take in

significant operating funds through fees. Some indi-
viduals or groups participating in adapted aquatics
programs, however, may not have the discretionary
income to pay such fees. Moreover, costs associated
with providing adapted aquatics programs may be
proportionally greater than those of other programs,
resulting in higher fees. Thus, your organization may
have to look elsewhere for funds to support programs
or supplement revenues.
Direct Solicitation
Your organization may choose from many different
methods for directly soliciting individuals and groups
for financial support, including annual giving or
direct mail campaigns, corporate sponsorships, grant
applications, and major gifts programs. Each of these
funding methods requires organization, expertise,
and a support structure. Annual giving campaigns
involve personal and mail solicitation, maintenance
of a database to track contributors and their giving
Looking for Help in All the Right Places!
When seeking advice for organizational devel-
opment, align with local organizations that link
to national associations, thereby broadening
your network. Here are descriptions of a few
organizations that provide many opportunities
for technical assistance, resources, and referral.
You can find links to local associations on the
corresponding Web sites.
The National Council of Nonprofit Associa-
tions (NCNA) is a membership-based organi-
zation of state and regional associations that
represent thousands of nonprofits throughout the
United States. NCNA members work at the state
and local levels to provide training and techni-
cal assistance to improve the operations and
effectiveness of organizations while promoting
the value and accountability of the nonprofit
sector. A list of local members may be accessed
through the NCNA Web site (www.ncna.org).
United Way of America is the parent orga-
nization of the approximately 1,400 community-
based United Way organizations in the United
States. Each community-based organization
is independent, separately incorporated, and
governed by local volunteers. United Way orga-
nizations spearhead community-wide efforts to
raise funds, build partnerships, forge consensus
on community needs, leverage resources, and
promote and monitor management standards
Program and Organization Development 93
histories, correspondence with and recognition of
contributors, and financial management of incoming
contributions. Soliciting corporate sponsorships and
foundation, corporate, or government grants requires
researching the most appropriate contributors for
adapted aquatics programs, cultivating relationships
with the contributors, securing key individuals such
as community representatives and volunteers to assist
with the funding requests, developing and present-
ing a case for giving, processing grant applications,
and communicating effectively. Major gifts programs
require making potential contributors sensitive to the
mission of the organization and the need for support
and cultivating and maintaining long-term relation-
ships with the contributors.
In-Kind Support
In-kind support—noncash contributions of goods or
services—can defray the cost of operating adapted
aquatics programs. For example, you can solicit much
for organizations funded through United Way
(www.national.unitedway.org).
The Association of Fundraising Professionals
(AFP) represents 26,000 members in 174 chapters
throughout the United States and abroad work-
ing to advance philanthropy through advocacy,
research, education, ethical standards, and cer-
tification programs. Local chapters may provide
routine training, mentoring, membership scholar-
ships, and consultation (www.afpnet.org).
The Grantsmanship Center (TGCI), founded
in 1972, offers grantsmanship training and low-
cost publications to nonprofit organizations and
government agencies. TGCI conducts some
200 workshops annually in grantsmanship and
proposal writing. These workshops are hosted by
more than 100 local agencies (www.tgci.com).
The Foundation Center provides a clearing-
house of information about U.S. philanthropy,
education and training on the grant-seeking
process, and Web site access to specific funders
(www.fdncenter.org).
Council on Foundations (COF) is a mem-
bership organization of more than 2,000 grant-
making foundations and giving programs world-
wide. COF provides leadership expertise, legal
services, and networking opportunities—among
other services—to members and the general
public (www.cof.org).
94 Adapted Aquatics Programming
of the needed instructional equipment and materials,
including life jackets, kickboards, flotation aids, pool
toys, tot docks, Transfer Tiers, Wet Vests, goggles, stop-
watches, and lifts, from local vendors and manufac-
turers. Pool time is another type of in-kind donation
appropriate for adapted aquatics programs, whether
your organization is conducting a single program or
trying to expand the program to various locations in
the community. Finally, you may be able to secure
services, including legal, nursing, and PT or OT ser-
vices, through in-kind donations.
Special Events
Many groups have used special events to raise funds
to support programs. Don’t underestimate how labor
intensive and time consuming such events can be. Still,
special events are often worth the effort, as they also
provide an excellent opportunity for program promo-
tion and recognition. An active, diverse, and dedicated
committee should plan carefully for success.
Facilities Acquisition
Perhaps your group or organization offers adapted
aquatics programs but is not fortunate enough to
own a pool; instead, you have found an affordable,
accessible alternative by using another organization’s
facilities. Or maybe you have the aquatics facilities
but have not considered expanding your programs to
include adapted aquatics until now. Where should
you look for aquatics facilities to use if you don’t
have them or if you need ideas for adapting the
facilities you do have? Many for-profit and nonprofit
organizations and facilities may be able to help you,
including
• organizations with private, community-based
facilities known to provide year-round aquatics
programs, such as YMCAs, YWCAs, Boys and
Girls Clubs, and Jewish Community Centers;
• public and private schools;
• organizations providing direct services to indi-
viduals with disabilities, such as United Cere-
bral Palsy, Easter Seals, and Special Olympics;
• summer camps sponsored by any organiza-
tion;
• hospitals and rehabilitation centers;
• residential facilities;
• universities;
• publicly funded organizations such as park and
recreation facilities and community centers;
• community-based, corporate, and private fit-
ness facilities;
• hotel and motels; and
• residential facilities such as developments and
condominiums.
Chapter 2 also discusses settings for the four treat-
ment models. All of these organizations and facilities
may provide you with opportunities for developing
adapted aquatics programs by (a) incorporating your
programs into their existing lines of service; (b) rent-
ing their facility to your group, whether your group
is internal or external to the organization; (c) provid-
ing the facility to your group as an in-kind donation;
(d) initiating a collaborative program that mutually
benefits their organization and yours; or (e) adding an
adapted aquatics program to enhance the programs
they currently offer.
One approach for soliciting pool space is to market
the benefits that organizations will derive from spon-
soring an adapted aquatics program. Consider an
example whereby a Special Olympics chapter secures
pool space from a local YMCA. Special Olympics
has the opportunity to offer an aquatics program at
an organization that is recognized for its aquatics
programs and is also structured to deliver services
to the community. The YMCA has opportunities for
program outreach, expanding its customer base,
developing a partnership with another community
organization, and achieving its mission by providing
a needed service.
Risk Management
The ceiling over the pool collapses. A fire destroys
the locker rooms. A participant trips over instructional
equipment, falls on the pool deck, and breaks his
arm. A parent threatens to file a lawsuit because she
feels your organization has not made an appropriate
accommodation. An instructor provides inaccurate
and sensitive information to the media about medi-
cal issues pertaining to one of your program partici-
pants. These situations demonstrate a few of the risks
that your organization, staff, and customers might
confront. Responsible organizations implement risk
management programs to anticipate and avoid such
situations. Specifically, risk management programs
develop basic measures that identify, evaluate, elimi-
nate, reduce, and transfer risks (Rakich, Longest, &
Darr, 1985).
There are many ways to manage risks, including
the following (Horine, 1995; Rakich et al., 1985):

• Insurance protection. Consider obtaining suf-
ficient coverage to protect against financial losses
from liability, fire, theft, and vehicle accidents and
to provide for workers’ compensation. Circumstances
might also warrant additional insurance coverage for
volunteers, athletic events, and so on.
• Policies and procedures. Emergency action
plans, communication protocols, operations manuals,
and personnel policy manuals are documents that
your organization might develop to guide the actions
of staff in preventing or dealing with hazardous situ-
ations. Such documents should clearly define roles
and responsibilities and outline appropriate actions.
Most importantly, the administration must regularly
disseminate, explain, and review the information in
these documents.
• Records and reports. Opportunities to identify
risks and follow up and prevent future risks result from
comprehensive records and reports. Many aquatics
facilities use accident, injury, and incident report
forms to document follow-up and preventative mea-
sures. Registration records, participant information
forms, and medical release forms can also help you
identify potential risks related to specific individuals
or groups.
• Safety audits. Through comprehensive and
regular investigations of facilities and equipment,
audits can identify potential hazards that your orga-
nization may be able to eliminate or control. Items
such as loose bolts on a diving block, a jagged edge
on the pool stairs, or a missing skimmer cover might
easily go unnoticed and possibly cause injury if an
organization fails to conduct regular safety audits.
• Staff training. Since situations of risk involve
people, it becomes critical that those responsible
for managing risks are trained accordingly. It seems
obvious that skills in first aid, CPR, and lifeguarding
enable aquatics staff to manage risks; however, each
organization must determine what other training
related to risk management is appropriate for which
staff members. Staff training should answer these
types of questions: Do staff members have appropriate
training to handle pool chemicals? In an emergency,
who can communicate with program participants
who are deaf? How will participants who require a
lift to enter and exit the pool be removed from the
pool if that lift breaks?
• Customer and participant education. Since
there are usually more program participants than
staff in an aquatics program, it makes sense to engage
the participants in preventing accidents and avoid-
ing risks. For this reason, aquatics facilities should
post rules, orient participants to the program and the
Program and Organization Development 95
facilities, have everyone involved practice emergency
drills, and provide literature about the program. Cre-
ative efforts to educate pool patrons about risk are a
more proactive approach to risk management than are
attempts to discipline patrons after they have engaged
in risky behavior.
• Equipment. Quality safety, rescue, and instruc-
tional equipment can help staff prevent accidents
and effectively intervene if an accident does occur.
Adequate backboards, rescue tubes, ring buoys,
and first aid kits are basic equipment for effective
lifeguarding. Be aware, too, that injuries can easily
result from broken kickboards, damaged life jackets,
leaky face masks, and sharp-edged toys.
• Facility modifications. Nonslip surfaces,
temperature-controlled showers, appropriately
designed handrails, and easily accessible entrances
and exits are a few of the many facility features that
can reduce and prevent injury. Identify necessary
modifications through past injury reports and con-
sultation with pool design companies.
• Hold harmless and parental consent forms. In
an effort to transfer risk, many organizations have
required participants to sign forms in which they agree
not to sue if some future accident should occur. In
many instances, parents sign for minors. Since hold
harmless or exculpatory agreements cannot excuse
ordinary negligence or gross, wanton, or intentional
acts, there are many circumstances for which these
agreements do not hold up in court (Horine, 1995).
Perhaps a better approach to clearly informing parents
and participants about a program is through a paren-
tal consent form, which should include permission
to participate, an overview of program contents and
risks, medical insurance information, emergency noti-
fication information, participant medical information
(relevant to risk prevention and emergency care), and
permission to provide emergency medical treatment
(Horine, 1995). Because laws and court decisions
affecting these issues vary and change from jurisdic-
tion to jurisdiction, however, your program should
seek advice from an expert in liability insurance.
Your organization’s process of risk management
must identify, control, and resolve risks. Organi-
zational policies and procedures and detailed job
descriptions should clearly define responsibility for
risk management. Many organizations have legal
counsel and designated management staff to imple-
ment various components of the risk management
program. It is best to structure staff meetings, customer
surveys, and accident and incident reports so that
leadership can collect, review, and analyze crucial
feedback about managing risk.
96 Adapted Aquatics Programming
Program Development and
Evaluation
Critical to implementing safe, effective, and relevant
programs is the underlying notion that adequate
planning has been done to optimize the aquatic
learning environment. Designing the overall adapted
aquatics program, including assessment tools, indi-
vidual and group plans, and evaluation systems,
takes time, creativity, dedication, and comprehensive
knowledge regarding adapted aquatics, individuals
with disabilities, special education, general aquat-
ics, and multidisciplinary functioning. The following
sections introduce elements of program design and
components of evaluation that are integral to devel-
oping quality aquatics programs for individuals with
disabilities.
Elements of Program Design
Program planning begins with selecting a service
model and setting the corresponding goals. As
described in chapter 2, the model selected depends
on factors such as settings and facilities (e.g., schools,
community centers, rehabilitation centers) and
service providers (e.g., aquatics instructors, thera-
pists, recreation specialists), as well as on the target
population (e.g., people with physical disabilities,
people with cognitive disabilities, senior citizens). The
target population may be one that has traditionally
been underserved, one that is already served in your
particular facility, or one that has expressed interest
through a community needs survey.
Although the transdisciplinary model is recom-
mended, a specific, unidisciplinary approach may be
necessary. In addition, a competitive sports approach
might help guide the program. This approach shares
components of the educational and recreational
Table 5.1
Relationship Between Program Goals and Participant Goals
Program goals
To provide social experiences during aquatic participation
To provide instruction in swim strokes
To increase independent movement
To provide instruction in skills that promote safety and
survival in water
models, offering instruction and providing individuals
with leisure skills for pleasurable recreational expe-
riences. Competitive programs may function in any
of the settings that have been addressed and may be
directed by aquatics instructors, parents, therapists,
or recreational specialists who are interested and
trained in coaching swimming.
Beyond defining the thrust of the program, the
amount of collaboration desired, and the general
goals of the program, your organization must develop
a specific curriculum. Whether the focus of your
program is educational or not, the philosophy, goals,
scope, and sequence of skills that define your program
should make up the major parts of your curriculum.
The purpose of writing a curriculum, whether it is
for an individual or a group, is to provide direction
and continuity. Your curriculum should concentrate
on aquatic skills and their application in the lives of
individuals with a particular disability. Ask yourself,
“Are the goals relevant to the current needs of the
target group of the program?” Use the guidelines for
age-appropriate activities in chapter 3 to help you
further tailor your program’s goals.
Curriculum goals serve the mission statement,
guide the program, and reflect program philoso-
phy. They give the program purpose, determine the
program content, and are outcome oriented. The
program director first delineates the program goals,
which comply with the mission statement, and the
goals are then translated into desired outcomes. These
outcomes reflect what the program and participant
should accomplish. Table 5.1 shows the relationship
between program goals and participant goals. Next,
the program staff identifies the skills to be taught in
each class session, the appropriate learning progres-
sions, and the specific behavioral objectives for each
participant (see chapter 8).
The program staff continues program planning by
examining time, facilities, equipment, personnel, and
Participant goals
To increase number and quality of social contacts
To perform five basic swim strokes
To perform independent transfers for entering and exiting
the pool
To perform floating and self-rescue skills in deep water

the effects each of these has on content. Ultimately,
this program information serves as the basis for the
assessments and goals of the individuals who attend
the program.
Components of Program
Evaluation
Administration and staff must evaluate the many parts
of the adapted aquatics program to determine if the
participants are making meaningful gains and if the
program itself is safe, effective, relevant, and age
appropriate. Ongoing evaluation can quickly uncover
problem areas that your organization needs to address
in terms of facility planning, program planning, staff
development, and customer satisfaction. While some
programs opt for monthly, quarterly, semiannual, or
yearly evaluation, ongoing evaluation will help your
program respond more quickly to issues regarding
quality and appropriateness of instruction, environ-
ment, and planning.
While programs vary too much for us to suggest a
single method of evaluation, the following consider-
ations will give you suggestions for ongoing and post-
program evaluation pertaining to facilities, program
development, staffing, and customer satisfaction.
Adapt these ideas to fit your program’s needs.
Assuming that the staff has comprehensively
assessed facility accessibility (see chapter 6 for appro-
priate accessibility features), facility modifications
might address maintenance concerns and upgrades
that increase accommodation and expand program
options. Well-maintained and clean decks and locker
rooms, chemically balanced water, and accessible
areas are basic to any program. Use the following
questions to help identify other facility features that
may affect program quality:
• Does the lighting provide maximum visibility
throughout the entire facility?
• Are there areas in which accidents have
occurred?
• Are water and air temperatures satisfactory?
• Are there any drafty areas?
• Do the swimmers feel that the facilities and pro-
grams are accessible, usable, and desirable?
• Are there family changing areas that are acces-
sible?
• Are there waiting areas for parents, caregivers,
and significant others?
• Is the pool or instructional space too large or
too small?
Program and Organization Development 97
• Are extraneous noises of concern?
• Are there obstacles in close proximity to work-
ing areas?
• Are changing tables available in dressing
rooms?
• Are shower chairs or benches available in the
shower area?
• Does the pool have a variety of depths to facili-
tate a variety of activities?
• Are there adequate options for entry and exit?
While evaluation of individual program plans,
group lessons, and personnel should be continual,
evaluation of program goals may not be so fre-
quent. Although administrators and staff members
of adapted aquatics programs should constantly ask
themselves about the mission, philosophy, and goals
of a program, it may be years before they change their
program goals substantially. Possible goal changes
may result from changes in community, society, and
personnel. For example, as discussed in chapter 1,
aquatics programs for individuals with disabilities
went through great changes in the 1970s when federal
legislation mandated accommodation in education
programs and federally funded programs and again
in the 1990s with the renewed trend toward inclusion
in all aspects of life. When personnel change, a pro-
gram might subsequently change due to differences
in philosophy, training, and knowledge. Still other
changes may be brought about with a reexamination
of the individuals in the program, as in the example
that follows:
An adapted aquatics instructor for a community
agency was planning to give a presentation about her
program and so prepared some statistics regarding the
variety of individuals with disabilities. This process
revealed that half the participants were individuals
with traumatic brain injury, forcing the instructor to
reexamine the program goals and add more goals
directly related to interaction, communication, fol-
lowing rules, and physical fitness. Subsequently, she
determined that these goals better met the specific
needs of this group.
When evaluating an aquatics program, examine the
quality of interactions between the instructor and the
participants and among the participants themselves.
Also examine how participants react to task difficulty
and the entire process of how they are served in your
aquatics programs. The Program Evaluation Form
in figure 5.3 can help you examine the practices
of an organization and its staff as they provide
aquatics services for individuals with disabilities.
 Program Evaluation Form

Respond “yes” or “no” to each statement. “No” answers could indicate areas for improvement.

Assessment, Placement, and Individualized Program Plans

Y N 1. The aquatics staff has an established procedure for accommodating individuals with
disabilities.

Y N 2. The aquatics program provides a continuum of placements, including segregated, partially

included, and totally included settings for aquatics participation and instruction.

Y N 3. Aquatic assessment is conducted by an adapted aquatics specialist in conjunction with

other professionals (regular aquatics instructor, therapists, etc.), if warranted.

Y N 4. The adapted aquatics specialist uses an observation instrument for assessment.

Y N 5. The aquatics personnel attend team meetings to present information when appropriate.

Y N 6. All members of a transdisciplinary team, including professionals, parents, caregivers,

significant others, and the participant, have a voice in placement, goals, and objectives.

Y N 7. Individual programs are evaluated at least four times a year.

Y N 8. The individual plan includes present level of performance, annual goals, rationale for
goals, short-term objectives, projected dates to start and finish, and criteria for evaluation.

Instruction and Programming

Y N 1. The adapted aquatics program is periodically reviewed by outside expert evaluators.

Y N 2. A curriculum manual is available describing overall program goals, philosophy, rationale,

benefits, assumptions, and aquatics instructional services for individuals with disabilities.

Y N 3. Aquatics instruction for individuals with disabilities takes place under the guidance of
certified adapted aquatics instructors.

Y N 4. Adapted aquatics instruction for individuals with severe disabilities takes place with one
support person per participant.

Y N 5. The adapted aquatics program contains a variety of swimming, water safety, and leisure
activities.

Y N 6. Instructors base aquatics instruction on individual goals as outlined in the IAPP.

Y N 7. Individuals with disabilities included in regular aquatics classes have the proper learning,
emotional, and physical support as defined by the IAPP.

Y N 8. The program focuses on what an individual with disabilities needs in order to participate
now and in the future in lifetime and leisure pursuits.

Y N 9. Aquatics programs for individuals with disabilities include goals for strengthening self-
esteem.

Y N 10. The organization gives individuals with disabilities who can succeed in regular
competitive athletics opportunities to do so.

(continued)

Figure 5.3  The Program Evaluation Form can guide your examination of an organization’s practices or overall pro-
gram.
Adapted from C. Sherrill and N. Megginson, 1984, “A needs assessment instrument for local school district use in adapted physical education,” Adapted Physical Activity Quarterly
1(2): 147-157.

98
 Program and Organization Development 99

Personnel

Y N 1. The organization leader ensures that program staff and participants are prepared to
embrace the diversity of abilities of individuals with disabilities.

Y N 2. A sufficient number of qualified personnel are available to meet the needs of individuals
with disabilities.

Y N 3. Certified adapted aquatics instructors deliver adapted aquatics services and instruction to
individuals with disabilities.

Y N 4. Administrators understand the scope of adapted aquatics services.

Y N 5. Administrators ensure that regular aquatics instructors have at least one in-service training
session each year on adapted aquatics concepts taught by specialists in this area.

Y N 6. Administrators ensure that instructor aides have appropriate in-service training each year
by an adapted aquatics specialist.

Y N 7. Administrators encourage aquatics instructors who want to improve their knowledge of

adapted aquatics.

Y N 8. Administrators grant release time for adapted aquatics instructors to attend team meetings.

Y N 9. Administrators understand the difference between adapted aquatics and aquatic therapy.

Y N 10. Staff maintains communication with parents, caregivers, and significant others.

Y N 11. Staff maintains communication with other professionals.

Y N 12. Instructors provide education to encourage family and caregiver involvement.

Figure 5.3  (continued)

You may also use this checklist as a general guide for
observing an overall program.
Let’s look specifically at how to evaluate aquat-
ics instructors. As a program manager responsible
for successful program implementation, you must
examine the teaching behaviors of your aquatics
instructors. First, however, your organization must
clearly identify the functions of an aquatics instruc-
tor working with individuals with disabilities. To
determine effectiveness, you measure how well the
instructors demonstrate these functions. Figure 5.4
is an observation checklist for evaluating effective
teaching behaviors. The statements listed in the figure
are criteria for assessing instructor effectiveness. By
rating the instructor on a scale of 1 (very effective) to
5 (very ineffective) for each list item, you determine
the degree of instructor effectiveness.
A final vital area of evaluation that is too often
neglected is determining how participants, caregiv-
ers, or significant others view the overall program
and aquatic experience. Interviews, observations of
compliance, and surveys are ways to obtain input
from the consumers your program serves. Participants
should provide feedback directly, but if they are
unable to respond it may be necessary to question
significant others. Figure 5.5, a consumer satisfac-
tion survey, models effective evaluation statements
for assessing consumer satisfaction. You can survey
consumers semiannually or more frequently. Use the
results to examine your current practices and to plan
for the future.
Human Resource
Management
As we have discussed, a sound organizational struc-
ture with appropriate facilities and a solid funding
base are essential to your organization’s success.
Delivery of services, however, depends on sufficient,
qualified staff members that understand their jobs
and the purpose of the organization. Competent
staff, including the program director, instructors, life-
guards, aides, and other personnel, ensure that your
program achieves its objectives, maintains quality
 Teaching Functions of an Adapted
Aquatics Instructor

For each item, rate the instructor on a scale from 1 (very effective) to 5 (very ineffective).

1 2 3 4 5

1. Reviews previous skills

2. Reviews physical, cognitive, and affective skills needed for new skill

3. States lesson goals and objectives

4. Uses task-analyzed teaching progressions

5. Provides proper explanations and demonstrations

6. Uses concrete examples

7. Uses key terms and cues

8. Checks for participant understanding

9. Includes all participants in instruction

10. Modifies tasks when too easy or hard

11. Displays enthusiasm for task presented

12. Uses a variety of communication modes

13. Brings participants back on task if they’re off task

14. Allows ample time for practice

15. Responds to all participants at a high rate

16. Gives tasks to participants that meet their individual goals

17. Structures practice so that participants spend a high percentage of

time engaged in motor activity

18. Aims for a high success rate

19. Provides general corrective feedback

20. Gives specific corrective feedback

21. Uses positive reinforcement

22. Uses principles of applied behavioral analysis when necessary

23. Uses routines for participants who need them

24. Directs paraprofessionals or aides to perform specific tasks

25. Offers safety tips

26. Motivates participants to learn new activities

27. Transitions smoothly from one activity or space to the next

28. Applies rules consistently

29. Promotes positive self-images of all participants

Figure 5.4  This form can help you evaluate instructor effectiveness.
Adapted from L.E. Randall, 1992, Systematic supervision for physical education (Champaign, IL: Human Kinetics), 55.

100
 Consumer Satisfaction Survey

Help us measure the success of this aquatics program. Check one box for each of the numbered categories.
Please explain “disagree” and “strongly disagree” ratings. If you have ideas as to how we might improve the
program, please share them with us.

Strongly Agree Disagree Strongly Unable

agree disagree to judge

1. Facilities met my accessibility needs.

2. Facilities were well kept.

3. Facilities were conducive to learning.

4. It was easy to join this program.

5. I felt comfortable with the process of being assessed

and discussing goals.

6. Ongoing assessment was shared with participants.

7. Program staff collaborated with others effectively.

8. Communication lines were always open.

9. Individualized Aquatics Program Plans were

developed with participant and, if appropriate,
significant others.

10. The atmosphere of the classes was positive and

conducive to learning.

11. The instructor provided specific goals to be

achieved at each session.

12. The instructor provided ample opportunity to

practice.

13. There was positive interaction among individuals

with varying abilities.

14. Instructor adapted activities and tasks to individuals’

levels of performance.

15. Instructor communicated in preferred mode.

16. Instructor included you in the entire session.

17. Instructor chose activities that helped you meet

your goals.

18. Enough equipment was available during sessions.

19. Equipment was of good quality.

Reasons for disagreeing with any statement:

Suggestions for improvement:

Figure 5.5  In addition to evaluating your program and instructors, you should determine how consumers view your program.

101
102 Adapted Aquatics Programming
and customer service, and delivers its services safely,
efficiently, and effectively.
Following a simple model of human resource
development, your organization should first define
which jobs will help achieve its and the program’s
goals (see figure 5.6). This information should then
drive decisions regarding job prerequisites, appro-
priate credentials for applicants, classification and
number of positions, performance management, and
training and development programs for maintaining
qualified staff. Subsequent human resource activities
may revolve around five broad tasks (Smith, Bucklin,
& Associates, 1994):
• Hiring and placement
• Fair and equitable compensation
• Communication among staff, management,
and volunteers
• Compliance with local, state, and federal
employment laws
• Maintaining and enhancing the organization’s
image
Job Analysis
A job analysis is studying a job to determine its
contents, a process appropriate for both paid and
volunteer staff positions associated with adapted
aquatics programs. The resulting information indicates
Job analysis
Prerequisites and credentials
Staff recruitment
Training and development
Performance management
Figure 5.6  A model for human resource development.
E3344/Lepore/fig.5.6/278225/alw/r2
the skills, experience, and training required for posi-
tions and guides decisions for the effective recruit-
ment, selection, and orientation of new staff (Rakich
et al., 1985). Organization and program leadership
may conduct a job analysis through observations,
questionnaires, and interviews. Information obtained
through a job analysis becomes the basis for a job
description, which summarizes job relationships,
responsibilities, qualifications, and conditions. The
analysis also assists in documenting job specifica-
tions for education, experience, physical skills, com-
munication skills, initiative, judgment, and training
(Rakich et al., 1985). These specifications provide
much guidance when recruiting for new positions
and interviewing job applicants.
Prerequisites and Credentials
A table of organization, such as the one in figure
5.7, identifies a hierarchy of staff positions. Each
position requires certain credentials for successful
job performance. An organization providing adapted
aquatics programs might expect its staff to possess the
following general characteristics: positive attitude,
willingness to do many tasks, flexibility, realism,
adaptability in meeting the needs of customers, and
acceptance of diversity. These characteristics apply
to both paid and volunteer staff, including program
directors, lifeguards, greeters, instructors, and locker-
room and pool aides.
Each position within your organization should
also require specific credentials to ensure a stan-
dard of performance and safety. The job analysis
should determine these credentials, which in turn
should be documented in the job description
and specifications. Consider the positions listed
under the manager of instructional and personal
development programs in figure 5.7. For such a
position, you might expect an applicant to have
received related training from organizations such
as the ARC, YMCA, AAHPERD, AEA, USA Swim-
ming, and National Safety Council, so that she
may adequately supervise aquatics instructors and
therapists. In addition, your organization might
require academic credentials such as a degree in
physical education, APE, physical therapy, exercise
and fitness, recreation, recreation therapy, or sports
management. Finally, your organization might
require an applicant to have previous experience
working with diverse populations of individuals
with disabilities, cross-training in different program
areas, and experience with other organizational
functions, such as staff development, fund-raising,
and financial management.
 Program and Organization Development 103

Executive
Administrative assistant
director

Manager of instructional and Manager of recreation

Manager of operations
personal development programs and sports

Aquatics Fitness Swim team Lifeguard Accounting

Custodian
instructors specialist coach supervisor clerk

Lifeguards

Aquatics Special activities

therapist coordinator

Figure 5.7  The Aqu-Achievements table ofE3344/Lepore/fig.5.7/278226/alw/r2

organization for paid staff.

Staff Development
Trainin
Effective recruitment finds staff members who are the g
best fit for their jobs. Effective training creates staff t
members with competencies tailored to their job en Skille
d
m

Ap

specifications. Naturally, keeping the same staff over

uit

time helps ensure program continuity and stability.

pra
r

d
Rec

lifie

Indeed, your organization invests in its success by

isal
Qua

M ot

retaining people who are well trained and appropri-

Staff
ivated

ately qualified. Finally, evaluating staff performance

and motivating staff are vital. Effectively developing
your staff requires a range of interrelated organiza-
tional activities (see figure 5.8).
ble
n

Ef
a

Recruitment St
tio

fec
Re

tive
en

After completing the job analysis and establishing og

c

t
credentials, the next task is to recruit candidates Re ni
tio
for the position. Typically, the administration places n
ads in newspapers, newsletters, and professional
journals and advertises through universities and
community organizations. Then, the administrative Figure 5.8 E3344/Lepore/fig.5.8/278227/alw/r2
Components of staff development.
104 Adapted Aquatics Programming
and management staff review resumes and screen,
interview, and select candidates. Although each of
these activities is routine to organizational operations,
management must generally devote much time and
effort to staff recruitment.
Alternatives to recruitment can result in qualified
and competent placements for staff positions. For
example, volunteers can contribute significantly to
the human resources of an adapted aquatics program,
while helping the program meet its budget constraints
and supporting the organization’s mission and phi-
losophies. Who might be willing to volunteer?
• High school and college students, particularly
those attending schools that require students to
complete community service projects
• Relatives of program participants
• Businesses that encourage community partici-
pation
• Community-based organizations with similar
missions and programs, such as the ARC,
United Way, United Cerebral Palsy, National
Multiple Sclerosis Society, and The Arc (www.
thearc.org)
• Professional groups for teachers, physical thera-
pists, and the like
• Local- and state-sponsored volunteer programs
such as the Retired and Senior Volunteer Pro-
gram (RSVP)
Volunteer participation and other alternative
recruitment strategies can create a diverse staff, dem-
onstrating sensitivity to customers and representing
the community. College internships and community
work-study programs provide low-cost ways to recruit
temporary staff, but these staff members may require
greater training and supervision. Each of these consid-
erations may affect the table of organization, thereby
influencing decisions about staff recruitment.
Training
A structured training program facilitates the imme-
diate and long-term maintenance of qualified staff.
Preservice training provides new adapted aquatics
staff members with the knowledge and skills to start
their positions. This training might include an ori-
entation to the facility and equipment, a review of
the operational procedures, a description of the staff
roles and responsibilities, a review of program objec-
tives and methods, and an overview of the customer
population.
In-service training provides a more comprehensive
development of job skills and competencies. Such
training for adapted aquatics staff might include
practice of program methods for participant skill
development, supervisory practices, medical and
emergency protocols, specific characteristics of the
client population, and program methods for a specific
disability. Through cross-training, your organization
might do a better job of ensuring the continuity and
stability of program delivery. Swim instructors, for
example, might cross-train to provide fitness programs
or to assist with therapy regimens. A final training
component, one that will strengthen your organi-
zation’s ability to retain qualified staff and provide
staff with opportunities for personal development, is
career development. Through such a program, staff
members have the opportunity to pursue training that
prepares them for higher level, technical, supervisory,
and management positions.
Many individuals, at different levels and with
varied responsibilities, contribute to the success of
adapted aquatics programs. While prerequisite cer-
tifications and credentials provide a foundation for
the necessary competencies associated with adapted
aquatics positions, additional and customized training
may be necessary for staff to fulfill job responsibilities
at specific facilities. You can customize supplemental
and in-service training in several ways:
• Emphasize and augment the contents of formal
training programs provided by organizations
such as AAPAR, the ARC, the YMCA, and uni-
versities (see references in chapters 1, 11, and
appendix F).
• Provide workshops led by organizations with
expertise specific to the swimmer population,
such as United Cerebral Palsy, Special Olym-
pics, and the NMSS.
• Provide training led by professionals with exper-
tise in skills beneficial to the swimmer popula-
tion, such as physical therapists, adapted physi-
cal educators, and clinical psychologists.
• Conduct workshops to help staff master the
use of special equipment such as lifts, mobility
devices, and flotation aids.
In-service or supplemental training can be effective
when the contents are customized to the specific roles
of the position and consider the swimmer population
and the characteristics of the organization. Figure 5.9
lists possible contents to be taught during customized
in-service or supplemental training.
Appraisal
Although effective staff training contributes sig-
nificantly to the delivery of quality programs,
 Program and Organization Development 105

Staff and Volunteer Positions

Adapted aquatics instructor
Instructor aide
Program aide
Lifeguard
Parent or caregiver

Content area Examples of competencies

Administration • Keeping records

• Following accident and incident procedures
• Communicating with participants, parents, and outside organizations
Instruction • Using instructional flotation and swimming aids
• Using methods beneficial to swimmer population (e.g., movement
exploration, academic reinforcement, etc.)
• Augmenting instruction with therapeutic or fitness components
Safety • Following emergency action plans
• Following medical and medication protocols
• Knowing special lifeguard procedures such as seizure control, rescue
breathing, CPR, and back boarding
• Understanding cautions specific to a swimmer population, such as
swimmers with atlantoaxial instability (see chapter 9)
Equipment • Using mobility equipment
• Using lifts and transfer equipment
• Using communication devices
Facilities • Knowing the general facility
• Knowing facility ADA modifications and accessibility
• Knowing emergency procedures or routes
• Knowing pool maintenance procedures
• Knowing locker-room, shower, and bathroom procedures
Specific population • Understanding of general characteristics
• Understanding of specific abilities and limitations (see chapter 9)
• Using interaction skills and communication strategies
• Performing pool entry and exit procedures
• Using assistive equipment and devices
• Knowing behavior management

Figure 5.9  A guide for planning and customizing in-service or supplemental training.

other performance management processes also standards based on organizational objectives.

affect programs. Performance appraisals pro- Lack of achievement may indicate a need for more
vide opportunities to objectively assess if a staff supervision, training, or resources for completing
member has successfully achieved performance the job.
106 Adapted Aquatics Programming

Recognition
At the same time, recognition of excellent perfor-
mance energizes and motivates staff to continue
meeting performance standards, to take initiative,
and to strive to achieve the organizational mission.
Management may provide recognition in a variety of
standard and creative ways, including informal verbal
and written praise, opportunities to attend training
programs and conferences, formal staff recognition
programs, and salary increases and promotions.
Performance appraisal and recognition are equally
important for paid and volunteer staff.
Retention
Of course, many of the components of human
resource development are interrelated. Performance
appraisals provide feedback for staff recognition,
training, and career development. If conducted in a
supportive manner, each of these processes may in
turn increase staff motivation, satisfaction, and reten-
tion, which helps your program maintain continuity
and stability.
Summary
You can build an effective and efficient organiza-
tion by developing and executing strategic plans,
securing adequate funding, acquiring appropriate
facilities, gaining community support, developing
organizational structure, implementing effective pro-
grams, ensuring risk management, developing human
resources, and communicating effectively internally
and externally. Communication and program pro-
motions enhance an organization’s ability to receive
positive recognition, acquire resources, and improve
program participation. Program development and
evaluation parallel organizational development by
generating program content based on the needs of
participants and input from individuals associated
with the program. Human resource development
helps an organization achieve its mission and deliver
quality programs by ensuring effective staff recruit-
ment, development, and retention.

Chapter 5
Review 1. Describe the major parts of a strategic plan and how these parts guide an
organization to achieve its mission.
2. In what ways might effective program communications and promotions
help to increase, improve, and sustain programs?
3. Identify four types of financial development activities and give examples
of how they might be applied to developing an adapted aquatics pro-
gram.
4. What are basic measures of a risk management program?
5. Identify an existing adapted aquatics program and describe each of the
elements of its program design, as identified in this chapter.
6. Describe three components of program evaluation and how you might
use evaluation for program development.
7. Describe how each of the functions of staff development helps to ensure
the delivery of a quality adapted aquatics program.
 6
Facilities, Equipment,
and Supplies

J  aye was a first-year university student who wanted to swim for fitness but had
problems accessing the pool, deck, lockers, showers, and dressing areas due
to use of a wheelchair. It was not that she was unable to independently operate
a door, locker, or hydraulic chair lift; it was that the design of the pool, lockers, and
lift did not allow for independent use. She had concerns about the accessibility of
the pool and its locker facilities after arriving for a recreation swim the first week
of classes. She found that the accessible locker room was also the swim team
room and was locked. She wheeled herself onto the pool deck to get a look at
the pool, only to find that the accessible lift was a 25-year-old, rusty, manual sling
seat lift that could not be operated independently. When at first she did not see
the lift, the lifeguard told her that it happened to be propped in a closet due to
a swim meet that was conducted the weekend before, as it was “sort of in the
way,” being so close to the warm-up pool.
There was no other means of pool entry for a person who used a wheelchair
even though this pool certainly had more than 300 linear feet (91.4 meters) of wall
(U.S. Access Board, 2003). Jaye decided that it would be a hassle to find a person
with a key each time she wanted to get into or out of the locker room. What if
the lifeguards were male and she had to use the bathroom in the middle of a
swim? How would she get into the accessible room? What if there was only one
guard on duty—how would he open the accessible locker room for her since to

(continued)

107
108 Adapted Aquatics Programming

do so he would have to leave the deck? And what if she just wanted to use the
accessible locker area for showering after her physical education class? Would
she have to find the aquatics director or the lifeguard for that? What about the
spirit of the ADA and its push for independence in the pool? How would she feel
about the lifeguard cranking the sling seat lift every time for her to enter and exit
the pool? Where was an independently operated lift like the one at her home
community pool? She wanted to let the university disabilities services know about
these problems, but did she have the right to make these requests?

I n the opening scenario, Jaye is well within her rights

to make her requests. In this chapter, we explain
and then demonstrate how you should apply specific
information to ensure that your facilities, equipment,
and supplies comply with the relevant technical
criteria for making facilities accessible. As you read
this chapter, keep in mind that the pool environment
must be safe and accessible as well as lend itself to
successful and satisfying experiences for participants
and instructors alike. You must be familiar with guide-
lines for accessibility, state and local health codes
for aquatics facilities, resources for equipment, and
supplies for aquatics participation.
As we discussed in chapter 1, the ADA has man-
dated that facilities comply with federal guidelines on
accessibility. Some federal requirements are very spe-
cific, such as standard minimum widths of doorways
and halls, and some are somewhat vague, such as the
need for reasonable accommodations and movement
toward access for existing facilities. Who makes the
rules about what is accessible in the United States?
The Access Board of the U.S. Architectural and Trans-
portation Barriers Compliance Board (ATBCB) is the
federal agency responsible for developing guidelines
for accessibility. In the 1990s, the Recreation Access
Advisory Committee was appointed to advise the
Access Board on accessible recreation environments.
Following the publication of the ADA Accessibility
Guidelines for Buildings and Facilities (Federal Regis-
ter, 1991), the Recreation Access Advisory Committee
published its recommendations for recreational facili-
ties and outdoor developed areas (Recreation Access
Advisory Committee, 1994), which included four
pages on aquatics facilities. In September 1995, the
ATBCB awarded a research contract to the National
Center on Accessibility (NCA) to identify and evalu-
ate methods of access to swimming pools (National
Center on Accessibility, 1996). In September 1996,
the NCA submitted its recommendations to the
ATBCB. Finally, in September 2002, the Access Board
published its accessibility guidelines, and a manual
specific to accessibility for pools, spas, and wading
pools followed (U.S. Access Board, 2003). On July
23, 2004, the guidelines were combined with the
newest rules and regulations for the entire ADA and
were published in the Federal Register, becoming
the standards for all public pools in the United States
(Architectural and Transportation Barriers Compliance
Board [ATBCB], 2004).
The recommendations for swimming pool acces-
sibility in this chapter are based on the July 23, 2004,
rules and regulations of the ADA. Ideal pool design
is not part of this law—the law includes only specific
access standards. There are pool designs that are
more user friendly for people with disabilities, and
no single pool design will satisfy all the demands of
a community. There are facilities designed around
competitive, therapeutic, portable, recreational,
freestanding, sunken, partially sunken, and deck-level
pools. More challenging areas of accessibility—lakes,
rivers, and oceanfronts—play an important role when
providing individuals with disabilities the opportunity
to transition into the broader world of aquatics that
naturally exists in society. Access standards from the
July 2004 regulations also include guidelines for
boating docks, water parks, and open water areas
(ATBCB, 2004).
In addition to proper facilities, equipment such as
flotation devices, lifts, transfer equipment, and moti-
vational supplies (toys, rafts, and tubes) increases the
available instructional strategies, but cannot replace
quality instruction. Don’t let a lack of innovative
equipment or the need for the perfect facility deter-
mine the quality of instruction or the placement of
individuals with disabilities within programs. Strong
pedagogical practices mandate that individuals with
disabilities are entitled to equipment and supplies
in an aquatic setting just as they are in a more tradi-

tional classroom or recreational program. Of course,
equipment and supplies needed for individuals with
disabilities vary with each participant, and therefore
facilities may not have a particular piece of equipment
designed for everyone’s success.
Chapter Objectives
From this chapter, you will learn the
following:
* The ADA has enormously influenced   address key issues that deal with swimming pool and
the facilities and program offerings in
private places in the public eye. Facility
accessibility and reasonable accommo-
dations allow many more people with
disabilities to use swimming pools and
join programs.
* outside of the venue. Accessible routes, including
There are primary and secondary means
of access to swimming pools and spas.
* There are many reasons to use adapted
equipment, but the most basic reasons
in adapted aquatics include entrance
and exit requirements, safety, support
and buoyancy, propulsion, fitness, moti-
vation, and fun.
Facilities
The facilities available for adapted aquatics programs
vary as much as the program purposes, goals, and
participants do. Facilities come in all shapes and
sizes, from 10-yard (9.1-meter) therapeutic pools to
competitive 25-yard or 25-meter pools and from 3-
foot-deep (0.9-meter-deep) pools for water-walking
to 16-foot-deep (4.9-meter-deep) diving wells. While
the various purposes of an aquatics program may lend
themselves to a specific facility design, all aquatics
facilities have locker rooms or changing areas, a pool
deck and pool, means of entering and exiting the
pool, and storage areas.
Community facilities operated by local govern-
ments and agencies, such as a town pool or YMCA
pool, serve a variety of uses, from competitive meets
to water-walking, and may be accessible but not
usable or desirable due to pool temperature, in-pool
features, or ease of use. Therapeutic facilities, oper-
ated by rehabilitation hospitals, private therapists, and
residential agencies, are generally built for a single
purpose, and may have greater accessibility, utility,
and desirability for individuals with disabilities, but
Facilities, Equipment, and Supplies 109
may not be open to the general public. Current design
trends for most facilities are for multiple uses, com-
bining recreational, instructional, competitive, and
therapeutic needs into a single facility. Unfortunately,
however, this practice may compromise conditions
for every one of the uses. Information on aquatic
facility design can be gleaned from several articles,
including “Good Therapy” by Mike Koch (2004) in
Aquatics International and “ADA Compliance for
Pools and Wet Areas” by Alison Osinski (1998) in
Fitness Management. In the following sections, we
locker accessibility and reasonable accommodations
under the ADA.
Accessibility
What, then, is accessibility? Accessibility removes
architectural barriers, ensuring easy access from the
parking spaces on an accessible egress with sufficient
room for vehicles, visible and safe flow of pedestrian
traffic, curb cuts, ease of movement into and through-
out the facility, and clear signage, are required. Ade-
quate parking (including accessible spaces for vans),
user-friendly entrance and exit doorways, proper signs,
ramps, elevators, open meeting areas, and braille
on doorway entrances to offices, activity areas, and
bathrooms are also required (see sidebar on acces-
sibility guidelines on page 110). Remember, the ADA
requires all places of public accommodation, such
as camps, playgrounds, auditoriums, fitness centers,
community recreational facilities, and gymnasiums, to
provide equal access to the same goods and services,
in the most integrated setting appropriate, to individu-
als with and without disabilities. Another important
concept of this law includes providing reasonable
accommodations in communication, transportation,
and programming. Making sense of ADA guidelines
can be difficult, and there are many areas of pool
facilities that cause concern for accessibility (Lepore,
2004). This chapter will help you avoid many access
pitfalls, from overlooking subtle pool maintenance
issues to lacking proper pool access.
In order to ensure accessibility, your aquat-
ics facility should have an ADA committee that is
familiar with ADA standards and federal guidelines.
Individuals with disabilities from the community
and participants with disabilities in your programs
should be on this committee. General and adapted
aquatics instructors should have representatives
on the committee to provide input on accessibility
issues. This committee should conduct a compliance
check by using an ADA facilities checklist and tour-
ing the facility. The Americans with Disabilities Act
 Examples of Accessibility Guidelines for Facilities
Parking tions; maximum water temperature is 120
°F (48.9 °C)
Required minimum
❚ Doors and partitions on bathroom or
number of accessible Total number of
changing stall afford privacy to users
parking spaces spaces in lot
❚ Bench seats in dressing room are same
1 1-25 height as wheelchairs (16-19 inches, or
2% of total 501-1,000 40.6-48.3 centimeters)
At least 1 accessible van spot per 6 accessible ❚ Bathroom or single-user or unisex toilet room
spots is allowed to meet accessibility as long as
it is located in the same area on the same
floor—if it is technically infeasible to alter
Routes and Entrances
a bathroom
❚ At least 1 accessible route provided from an
accessible parking space or an accessible Pool Deck
passenger or loading zone provided for an
accessible entrance ❚ All deck space in an accessible route
meets guidelines for accessible routes,
❚ At least 60% of public entrances comply with a width of at least 36 inches (91.4
with accessibility centimeters), with occasional spaces for 2
❚ Routes are at least 36 inches (91.4 centi- wheelchairs to pass, and with a maximum
meters) wide slope of 1:12; access routes not required
❚ Door openings are at least 32 inches (81.3 for raised diving boards, raised platforms,
centimeters) wide and waterslides
❚ Ramps are not steeper than 1 inch:12 ❚ Clear deck space of 36 inches (91.4 centi-
inches (2.5 centimeters:30.5 centimeters), meters) wide and 48 inches (121.9 centime-
meaning at least 1 foot (30.5 centimeters) ters) forward is provided next to a lift, on the
of ramp length for each 1 inch (2.5 centi- side of the seat opposite the water
meters) of height; handrails are provided if ❚ On transfer walls and near transfer systems
ramp has a rise of 6 inches (15.2 centime- there is a minimum clear deck space of 60
ters) or more by 60 inches (152.4 by 152.4 centimeters);
❚ Braille signs below corresponding text slope of clear deck space is no greater
than 1:48 or 2% grade
❚ Doors require a maximum of 5 pounds (2.3
kilograms) of force for pulling or pushing;
best door hardware can be operated by Pool Entries and Exits
a closed fist ❚ Newly designed, newly constructed, or
significantly altered pools have at least
Locker or Dressing Rooms one primary means of access (lift or sloped
entry); a secondary means of access is
❚ At least 5% but not less than 1 locker per
provided if the pool has over 300 linear
dressing area in each cluster is accessible
feet (91.4 meters) of pool wall or if access is
❚ In lockers that are accessible, maximum limited to one place (e.g., as in a lazy river
side and forward reach is 48 inches (121.9 pool at a water park); Brown, 2003
centimeters) with a maximum reach depth
❚ A lift or sloped entry is one of the primary
of 25 inches (63.5 centimeters) or 44 inches
means of access; secondary means is a lift,
(111.8 centimeters) if depth exceeds 20
sloped entry, transfer wall, transfer system, or
inches (50.8 centimeters)
pool stairs that meet the ADA code; if used, a
❚ At least 1 accessible shower, either a sloped entry (sometimes called a wet ramp)
transfer or roll-in type, with grab bars, a connects the deck directly to the water
folding seat, and a shower spray unit that through a gradual ramp, has handrails, and
can be used in fixed and handheld posi- has a flat landing area at the bottom
From the Americans with Disabilities Act (ADA) Accessibility Guidelines for Buildings and Facilities, and the Architectural Barriers Act (ABA) Accessibility Guidelines (Archi-
tectural and Transportation Barriers Compliance Board, 2004).

110

Checklist for Readily Achievable Barrier Removal
(1995), written by the Adaptive Environments Center
and Barrier Free Environments, is easy to use and is a
good overall checklist for existing facilities, although
it does not include specifics to the pool itself. It can
be accessed on www.usdoj.gov/crt/ada/checkweb.
htm. You can find other practical ideas for imple-
menting the requirements of the ADA in the book
Accessible Swimming Pools and Spas: A Summary of
Accessibility Guidelines for Recreation Facilities (U.S.
Access Board, 2003). Although not up to date with
recent guidelines, the book Leisure Opportunities for
Individuals With Disabilities: Legal Issues (Grosse &
Thompson, 1993) gives suggestions that stand the test
of time, including the following:
• Review current policies for program admission,
registration procedures, health information
forms, and other documents to guarantee that
the language in the forms and the admission
requirements do not discriminate in any way.
• Review the training program for new employ-
ees. Disseminate information regarding non-
discriminatory language and procedures and
ways to respectfully assist individuals with
disabilities.
• Develop resources in the community and on
staff for using communication aids, sign lan-
guage, and lifts and for assisting with wheel-
chairs and transfers. Keep names and phone
numbers of advocates in the community and
of interpreters for people who are deaf in a
convenient location. Call on these resources
immediately in the event of communication or
physical accessibility issues.
Administrators of aquatics facilities should know
what the terms readily accessible and readily achiev-
able mean in relation to the ADA (see chapter 1). In
addition to following the standards for accessible
pools, pool operators and the facility ADA commit-
tee should address usability, which is the ability of
participants with disabilities to actually participate in
the programs of the facility, not to simply access the
architectural components of the building. To create
usability, ensure that your program accommodates
participants with disabilities by adapting instruction,
activities, equipment, and supplies.
Making your program accessible and usable means
that you provide individuals with disabilities the
aquatics services you offer to individuals without dis-
abilities. Make it your goal to adapt existing programs
or create new programs that are as close as possible
to the general recreation or instructional programs
Facilities, Equipment, and Supplies 111
afforded all users. Then, ensure that staff members
are aware of the needs of consumers with disabilities,
are trained to meet those needs in a personable and
respectful manner, and are aware of the need to treat
individuals with disabilities as valuable consumers of
your organization’s services. What else can you do?
Work to make the general conditions more usable.
For example, keep air and water temperatures ade-
quately warm, offer additional times to swim when
the facilities are not overcrowded, and provide safety
and supervision in an environment without attitudes
that create barriers. Your efforts will pay off as you
create a program more desirable to consumers with
disabilities.
Locker Room
The locker room can be a place of great frustration
for individuals with disabilities. Factors such as inade-
quate lighting or combination locks that impede inde-
pendence for people with arthritis, poor fine motor
control, or upper-body amputations do not motivate
individuals with disabilities to use a facility. Many
other factors may inhibit independence, including
benches cemented into the floor in front of lockers,
shower area ledges or lips that limit access for par-
ticipants in wheelchairs, and lack of braille signs on
lockers and entrances and exits. Because a participant
must succeed in the locker room in the aquatic experi-
ence, it is imperative that your organization adapt its
locker rooms to increase independence, safety, and
success. Fortunately, since the July 2004 guidelines
for accessible design were issued, adapting the locker
room is relatively easy once you have the standards
in hand (www.ada.gov) and a group of people with a
variety of disabilities who are willing to provide input
into possible changes. The guidelines have specific
standards that detail how to achieve accessibility in
pools, locker rooms, bathrooms, and showers.
Starting from the entrance to the building, doors
must have an unobstructed opening at least 32
inches (81.3 centimeters) wide, open to at least 90°,
and lead to a 36-inch (91.4-centimeter) minimal
accessible route to the locker rooms. Counters for
check-in should be no greater than 36 inches (91.4
centimeters) high, and if a person has to swipe a
membership card or sign in, the areas for doing so
should be a maximum of 25 inches (63.5 centimeters)
into the counter. Doors to the locker room should
meet the same criteria required for the front doors,
have doorknobs that can be operated with a closed
fist, and need less than 5 pounds (2.3 kilograms) of
pressure to open (as should the front doors). Path-
ways to the lockers should be wide enough for two
wheelchairs to pass each other or at least 36 inches
112 Adapted Aquatics Programming
(91.4 centimeters) wide with occasional wider areas
that allow passing. The accessible route should be
clear of protruding objects, and objects mounted on
walls above the standard sweep of canes (for patrons
who are blind, 27 inches, or 68.8 centimeters) and
below the standard headroom clearance of 80 inches
(203.2 centimeters) should be limited to a 4-inch
(10.2-centimeter) depth.
At least 5% (but no fewer than 1) of the dressing
and locker rooms in each cluster are required to
meet accessibility standards; this amount also applies
to lockers. The ADA does not mandate the removal
of benches that are secured to the floor in front of
lockers, but it does mandate that the reach length
meet specific standards. In general, lockers with
benches secured in front are too much of a reach for
participants who use wheelchairs (see Examples of
Accessibility Guidelines for Facilities on page 110 for
reach standards). Lockers should have handles that
are large, thick, and easy to manipulate; it is best if
the handles can be operated with a closed fist. Key or
touch-pad locks may be easier to use than combina-
tion locks. One aquatic or shower chair should be
located in each locker room, and adequate space for
storing wheelchairs is necessary if participants transfer
out of them when using aquatic or shower chairs.
Braille maps and accessibility signs giving direc-
tions to the shower, locker, bathroom, and pool must
be posted on the wall outside of doors, not on the
doors themselves, so that no one gets injured by an
opening door while reading the braille. Nonslip floor
surfaces, such as indoor–outdoor carpeting strips or
rubberized matting, are preferable. Handrails are
recommended for ambulatory participants who may
have poor balance when their feet or crutches are
wet.
Hair dryers should be placed at varying heights
to enable people in wheelchairs to use them, with a
maximum reach of 48 inches (121.9 centimeters) and
a minimum reach of 40 inches (101.6 centimeters).
The locker room needs toilets, sinks, towel dispensers,
and soap dispensers that meet standards for acces-
sibility. Showers should have nonskid floors and be
free of lips. There are two types of showers for locker
rooms that meet ADA standards: a transfer type of
shower, in which a person comes out of his chair
to move onto a seat, and a roll-in type of shower,
in which a person remains in a shower chair or an
aquatic chair. Grab bars and shower spray units that
can be used in both fixed and handheld positions
shall be provided in roll-in showers. A stationary or
folding seat is necessary in transfer showers. Water
should be thermostatically controlled (with a maxi-
mum of 120 °F, or 48.9 °C) by easy-to-turn valves with
long handles and brightly colored raised numbers
to indicate temperatures around the valve; braille
should be included.
Additional locker-room amenities might include
wide benches (minimum of 20 inches, or 50.8
centimeters, deep; maximum of 24 inches, or 61.0
centimeters, deep; 17-19 inches, or 43.2-48.3 centi-
meters, high), changing tables, or mats for dressing.
Overhead heat bulbs and changing areas that are not
drafty are a plus. Partitions and doors to afford privacy
that is equivalent to that afforded other users must be
provided. If it is technically infeasible for your facil-
ity to provide accessibility, usability, and desirability
in the general locker room, it must provide a sepa-
rate or private area for individuals with disabilities.
Unisex changing and showering rooms, such as a
family changing room, are a typical addition to the
locker rooms of the 21st century, and these rooms
make good sense for parents with young children
and caregivers of people with disabilities who are of
opposite gender.
Pool Area
Unique architectural design can help a multipurpose
aquatics facility meet the needs of many diverse
groups. Although the uses of a pool should drive its
design, unfortunately it is often the money budgeted
for the project that dictates the size, shape, and ame-
nities. Often aquatics instructors are not included on
the aquatics facility construction project team, and
they therefore must work with what is already there.
In this section, we’ll describe ideal pool decks, ideal
access components of pools, and then the ideal pool
itself. For more information on the planning, design,
and construction of a pool facility, with ideas about
unique features for people with disabilities, see Dief-
fenbach (1991), Koch (2004), Osinski (2003), Poteat-
Salzman (2002), and Reid Campion (2000).
Pool Deck
Every aspect of the pool significantly influences the
entire aquatic experience, including the pool deck
design and safety features. A pool deck may be flush
with the water or several inches higher than the
gutters and water. The deck-to-water height should
be “no more than 15.24 centimeters and preferably
7.62 centimeters; too great a height decreases the
ease of entry and exit over the side and increases
the difficulties of handling in an emergency” (Reid
Campion, 2000, p. 5). Accessible design features
include unobstructed pathways a minimum of 36
inches (91.4 centimeters) wide, with occasional
room for two wheelchairs to pass, that connect all

features of a pool except raised diving boards and
platforms, lifeguard stands, and waterslides. Clear
deck space is required around the entry and exit
elements such as the lift, transfer wall, and transfer
system. A space of 36 inches (91.4 centimeters) wide
by 48 inches (121.9 centimeters) forward is required
around the seat side of a lift. For transfer walls and
transfer systems a clear deck space of at least 60 3
60 inches (152.4 3 152.4 centimeters) is required,
as well as a slope no steeper than 1 inch:48 inches,
or 2.5 centimeters:121.9 centimeters (a 2% grade). In
addition, the needs of some individuals are best met
with pool decks that are free from clutter and have
additional space (possibly off the deck) in order to
accommodate wheelchair storage, additional shower
chairs, crutches, transfer equipment, flotation devices,
seizure mats, and service animal kennels.
At any given time, multiuse facilities have a lot of
equipment and supplies on the pool deck. If you are a
pool administrator, consider the following suggestions
as a minimum for deck safety. Floors around the pool
should be nonslip but nonabrasive. Surfaces should
slope down slightly to facilitate drainage (Griffiths,
2003). Decks should be kept clean and safe by ban-
ning outdoor shoes on the deck. Consider covering
the deck with rubberized flow-through safety mats
or other sanitary, slip-resistant tiles, especially along
high-traffic areas from the shower to the pool edge.
Mop-on products can also create antiskid surfaces
on wet areas.
Figure 6.1  A transfer wall facilitates easy transfer from wheelchair to pool but can be difficult to use for exit.
Facilities, Equipment, and Supplies 113
The point at which the deck meets the pool edge
(coping) should have depth markings and contrasting
colors and textures and should not be sharp. Con-
trast in color and texture is especially important for
people with vision impairment if the deck is flush with
the gutter system. Coping with a slight lip is easily
detected by people who are blind and use a cane for
mobility and orientation.
For pools constructed with a transfer wall, the wall
is raised 16 to 19 inches (40.6-48.3 centimeters) above
the deck, or about the height of a wheelchair seat.
The top surface should be 12 to 16 inches (30.5-40.6
centimeters) wide, allowing participants to transfer
directly from their wheelchairs to the wall and into the
pool. In figure 6.1, the deck is below the water level
and leads to a transfer ledge by a dry ramp. To further
enhance pool entry, the water level should be as close
as possible to the top of the transfer wall and the wall
surface must have rounded edges and not be sharp.
Transfer walls may be an uncomplicated means for
independent pool entry, but they are more difficult to
use for exit. They may not be used as the sole method
of providing accessibility but may be a second feature
when lift or sloped entries are also provided.
Deck space is at a premium in any pool, with
walkways shared by lane line rollers, benches,
removable steps, lifeguard stands, and storage bins.
Clutter problems and narrow decks pose difficulties
for individuals with visual and orthopedic mobil-
ity concerns who use crutches, canes, walkers, or
Photo courtesy of Shawn Stevens
114 Adapted Aquatics Programming

wheelchairs. Especially at risk are individuals with

neuromuscular disorders who use a power wheel-
chair or crutches. The anxiety caused by being on
a narrow, crowded pool deck is enough to elevate
an already abnormally high muscle tone. Fears of
running into an obstacle or maneuvering through
narrow spots or close to the water’s edge add to the
tension. Such trepidation, compounded by poor deck
maintenance, could cause an accident, such as an
individual inadvertently driving her wheelchair into
people, obstacles, or the pool. Individuals who have
poor balance or use crutches, walkers, or canes are
especially at risk when a pool deck is narrow or clut-
tered. Osinski reports that “slip-and-fall accidents are
the most common reasons for lawsuits being filed in
the aquatic environment” (2003, p. 68).

Pool
In this next section, we discuss the pool itself, includ-
ing pool entry and exit; pool depth, width, and length;

Photo courtesy of Shawn Stevens

and water temperature and quality.
Entry and Exit
Once a participant maneuvers himself through the
locker room and onto the deck, he must then tran-
sition into the pool. Your facility must provide the
means to safely and independently as possible move
between the pool deck or wheelchair and the water.
“Provide a facility that offers maximal independent
entrance, use, and exit for all participants, while
drawing as little attention as possible to the process”
(Osinski, 2003, p. 68). Depending on various ADA
requirements, the linear footage of your pool perime-
ter, and the differing abilities among your participants,
your program may require more than one mode for
safe and dignified entrance and exit.
Facility design and accessibility equipment help
provide safe access. Sloped entries (wet ramps),
transfer walls, and gradual steps with handrails are
examples of built-in methods of transferring into the
pool. Sloped entries (see figure 6.2) are one of two
primary means of entry that meet accessible design
requirements. The facility should provide aquatic
chairs so that participants who use wheelchairs can
use these ramps. Dry ramps are constructed into the
pool deck outside of the pool and lead to a transfer
wall, while wet ramps connect the deck directly to
the water. Regardless of which ramp is used, the U.S.
Access Board (2005) offers specifications in the ADA
Accessibility Guidelines (ADAAG) that comply with
the relevant technical criteria for accessibility.
Dry ramps leading to a transfer wall (as seen in
figure 6.1) provide a gradual slope on the outside of
an in-ground pool, bringing the pool deck below the
Figure 6.2  Sloped entries are one of two ways to meet
the ADA requirements for the primary means of pool
access.
water surface. They provide a transfer point for people
who use wheelchairs, have difficulty bending down to
sit on a pool deck, or cannot use a ladder or steps.
Avoid inset ladders as much as possible. These
ladders, with their steps in the wall of the pool, are
difficult to navigate for individuals with poor strength,
visuomotor coordination, or balance or for individu-
als with arthritis or other joint dysfunction. Gradually
sloping steps (see figure 6.3) are a helpful adaptation
for many participants using the pool, including senior
citizens and children. Although used extensively in
in-ground backyard pools, sloping steps are rarely
built into indoor community pools because they take
up almost one lane of space. But you can purchase
portable stairs, ramps, and transfer systems (Transfer
Tiers) to use as movable access modes (see the equip-
ment section of this chapter).
Shape, Depth, Width, and Length
Unless you have the luxury of designing your own
pool, you are confined to the shape, depth, width,
and length of the pool at the facility where you teach.
Multi-use pools can be rectangular, oval, round,

Photo courtesy of Monica Lepore
Figure 6.3  Built-in gradually sloping stairs are a helpful adaptation for many par-
ticipants who have mobility difficulties but do not need a lift.
square, L shaped, Z shaped, and so on. Some instruc-
tors and therapists prefer a traditional rectangular pool,
as it has less turbulence than a curved pool has. Some
instructors enjoy pools with cutouts that allow users to
move out of the mainstream of the lap lanes.
Depths, lengths, and widths vary even more
than shapes. Teaching pools generally have about
40% shallow water and 60% deep water and have
an evenly sloping bottom. Most adapted aquatics
instructors prefer a pool with 60% shallow water
that is about 3 feet 6 inches (1.1 meters) deep. The
depth may vary with a sloping floor, steps as wide as
the entire bottom of the pool, or deep wells or bays
built in at one end. The best slope gradient for pools
with gradual slopes is between 1 inch:15 inches (2.5
centimeters:38.1 centimeters) and 1 inch:30 inches
(2.5 centimeters:76.2 centimeters). Very shallow
pools 2 to 4 feet (0.6-1.2 meters) deep are ideal for
teaching small children. Pools adapted for individu-
als with disabilities, in which caregivers and aquatics
instructors must provide support, are best with 60%
of the surface area at a water depth under 4.5 feet
(1.4 meters). If your entire pool is less than 4.5 feet
(1.4 meters) deep, however, you may need to limit
lap swimming and underwater activities.
Movable pool floors and bulkheads are other
ways to adapt community and therapeutic pools
for multiple uses. Movable pool bottoms, often
called hydraulic pool floors, can be installed during
pool construction or retrofitted in an existing pool.
Facilities, Equipment, and Supplies 115
They can be installed so that
they encompass the entire pool
bottom or only a section of the
pool floor. The movable floor is
constructed of reinforced con-
crete with a nonslip tile finish.
Hydraulic cylinders raise or
lower the movable pool floor
to any water depth needed for
instruction. If only a section
of the pool floor is movable,
various safety designs eliminate
the possibility of entrapment,
and the movable floor creates
a multipurpose pool. Since you
can position such a floor at
various depths, it is an excellent
way to accommodate children,
individuals with short statures,
individuals who cannot stand,
and inexperienced swimmers.
Shower chairs can be used to
facilitate the transfer of indi-
viduals who use wheelchairs
directly from the raised floor, which is then lowered
directly into the water, where they can swim or float
out of the chair (see figure 6.4). When you are not
using the pool, you can raise the pool floor to deck
level and eliminate the risk of reentry into the water,
maintain pool temperature, limit water evaporation,
and convert the pool area into an all-purpose room
available for nonaquatic events. Although movable
floors offer a great deal of flexibility and accommoda-
tion, the initial money outlay is large. Another con of
these floors is that the instructor needs to wait until all
participants are ready to enter and exit before moving
the floor. A lift still needs to be installed in these pools
for individual entry or exit and for emergencies.
Movable bulkheads can shrink very large pools
into smaller areas that better accommodate various
group sizes. The separation that bulkheads provide
allows you to safely run multiple activities concur-
rently. See appendix E for sources of movable floors
and bulkheads.
Water Quality and Temperature
Water quality is an issue that many aquatics instruc-
tors take for granted. As you probably know, the
purpose of pool water treatments is to destroy living
microorganisms and bacteria and to prevent the trans-
mission of disease (Griffiths, 2003). The goal is to have
balanced water to prevent pool scaling, corroded
equipment, skin and eye irritation, and unhealthy
air around an indoor pool. Water disinfection and
 116 Adapted Aquatics Programming
Photo courtesy of Shawn Stevens
Figure 6.4  Movable pool floors can transfer many individuals at once.
balance are important to decrease the potential for
swimmers to develop communicable diseases, rashes,
ear infections, and conjunctivitis. Recreational water
illnesses in the United States have been a concern
because there are new germs that can contaminate
water and cause illnesses (Centers for Disease Control
and Prevention [CDC], 2006).
There are several methods for disinfecting and
balancing your water. The most commonly used dis-
infection agents are chlorine, chlorine compounds,
bromine, PHMB (polyhexamethylene biguanide),
copper and silver ions, and ozone. Staff members
who are Certified Pool Operators are trained to handle
chemicals, disinfecting systems, and water testing
kits. Ideally, water should be tasteless, odorless,
and crystal clear. Pools in which the sole activity is
adapted aquatics have different circumstances than
multipurpose pools have, and often the water quality
in them is more difficult to maintain. Adapted aquatics
pools are normally kept between 84 and 94 °F (28.9-
34.4 °C), temperatures that are higher than the water
temperatures in multipurpose pools. Unfortunately, a
water temperature above 84 °F (28.9 °C) affects the
mineral (calcium) balance and the amount of disin-
fectant needed. Many pools with warmer water use
bromine or metal ions, as these chemicals dissipate
more slowly in warm water than chlorine does. See
Vest (1994, 1995) and Westbrook (1992) for more
information about various sanitation materials. If you
work in a pool with warm water, you should be con-
cerned with water sanitation and quality since body
pores open at high temperatures, making individuals
with low or weak immune systems
more susceptible to infection
(Osinski, 1989). Some disinfec-
tion products such as that sold
by Sanosil (www.sanosil.com)
are chlorine-free, have no danger
of bacteria resistance, and are
effective in temperatures of 32 to
203 °F (0.0-95.0 °C). The Sanosil
disinfectant, and others like it, is
made from hydrogen peroxide and
silver. It destroys all pathogenic
bacteria, amoebae, fungi, and
viruses.
There are times in an adapted
aquatics program when you must
clean up the pool after a fecal or
vomiting accident. Accidents such
as this, combined with improper
disinfection, allow bacteria to mul-
tiply and certain viruses to survive
and pose threats to subsequent
users (South Australian Health
Commission Department of Human Services, 1992).
Fecal matter can transmit Cryptosporidium, and some
people are worried about the transmission of HIV (the
virus that causes AIDS) through pool water. Although
there is no documented case of HIV transmission in
a pool, as HIV is susceptible to common chlorine-
based disinfectants and is diluted in vast amounts of
water (CDC, 1993), Cryptosporidium contamination
is widespread from fecal accidents. Cryptosporidium
is a microbe that can survive for some time in even
well-maintained pools and can cause illnesses such
as diarrhea. This particular organism is highly resis-
tant to chlorine and bromine disinfection and often
escapes sand and cartridge pool filters (International
Aquatic Foundation, 2005). Prevention in an adapted
aquatics program is the key. The following tips from
Griffiths (2003) should be part of your program’s risk
management plan:
• Don’t allow people who have diarrhea to
swim.
• Don’t allow people to swallow pool water.
• Mandate that participants be washed with soap,
especially around their rear end, before they
put their suits on.
• Take frequent bathroom breaks before it
becomes too late for the participant, and have
the participant shower after using the rest-
room.
• Do not allow diaper changes to take place on
the deck.

• Do not allow people who have experienced
diarrhea in the past 24 hours to use the pool.
• Develop disinfection guidelines for fecal acci-
dents.
The Centers for Disease Control and Prevention
distinguishes between procedures for formed stool in
the pool and procedures for diarrhea in the pool (CDC,
2001). Read the CDC fecal accident recommendations
on www.cdc.gov/healthyswimming/fecal_response.
htm, an excellent resource that gives step-by-step
responses to this problem. For any fecal accident that
occurs, (1) everyone must leave the pool, (2) as much
fecal matter as possible must be removed with nets or
scoops, (3) the filtration system must be allowed to do
its job for several hours. The number of hours depends
on state and local health codes, the amount of water
in the pool, and the filtration turnover rate. Vomiting
poses similar problems, and the CDC recommenda-
tions for disinfecting a formed fecal accident should
be followed when a participant vomits a full stomach
of food (Griffiths, 2003). Blood spills in pool water
have not been shown to be a threat. Blood on pool
decks is a problem that requires blood cleanup kits
and proper disposal. Universal precautions, body
fluid cleanup kit directions, and state and local health
regulations are very important to follow, and pool
policy should be established and followed.
Vest (1994, 1995) states that after a fecal or vomit-
ing accident occurs a pool should be closed for 24
hours so that four 6-hour turnovers may go through
the filtration system. In addition, the staff should
remove the fecal or vomit matter from the pool water
with a net or cheesecloth scoop, shock the accident
area with chlorine at a concentration of 20 to 30 parts
per million (thus superchlorinating the water), and
backwash and clean the filters with a chlorine-based
solution. Afterward, the staff should neutralize the
high chlorine level with sodium thiosulfate (reducing
the chlorine concentration to 5 parts per million) and
then backwash and clean the filter a second time.
Finally, the staff should test the water repeatedly over
the next few days to watch for bacteria problems.
Equipment and Supplies
Proper equipment and supplies are as important
for classes serving individuals with disabilities as
they are for classes serving the general population.
Equipment refers to items of a relatively fixed nature,
such as portable entrance stairs, hydraulic lifts, and
tot docks, while supplies are nondurable items that
have a limited time of use, such as kickboards and
Facilities, Equipment, and Supplies 117
flotation devices (Dauer & Pangrazi, 1986). When
planning the budget, consider the life span of each
piece, keeping in mind that equipment tends to
require more maintenance, needs periodic replace-
ment, and is higher priced. If your aquatics program
is to accomplish its objectives, you must have enough
equipment available for individuals with disabilities
to dress, enter the pool, participate, and exit the pool
as independently and efficiently as possible. More-
over, adequate supplies should be available so that
participants do not waste instructional time waiting
for equipment or supplies.
Equipment has been shown to enhance success,
increase motivation, and provide a challenge for
students who are learning to swim (Stopka, 2001a,
2001b, 2001c). There are many reasons to use
adapted equipment, but the most basic are for (1)
entrance and exit requirements, (2) safety, (3) support
and buoyancy, (4) propulsion, (5) fitness, and (6) moti-
vation and fun (Crawford, 1988; Heckathorn, 1980).
The following sections address these six categories
as well as equipment storage.
Entrance and Exit Equipment
and Supplies
Lifts, portable ramps, stairs, and ladders are important
for transferring participants into and out of the water
when no equipment is built into the facility. When
equipment is removable or temporary, it is constantly
being handled and therefore has a shorter life span
than built-in, permanent features have. Checking
the equipment each day before its use is a critical
component of the risk management plan.
Lifts
Lifts often provide the primary means of pool access
for individuals with severe orthopedic disabilities. In
addition, participants with acute disabilities, such as
postsurgical patients, may find lifts helpful. Lift equip-
ment varies from water-powered systems (figure 6.5)
to hydraulic systems (figure 6.6) to mechanical lifts
to fully automated lifts that are powered by battery
(figure 6.7). Lifts operate by suspending, pivoting,
lowering, and raising the participant. Some lift models
require a second party to operate, while others can
be operated by the participant alone, resulting in a
more independent aquatic experience. The newest
ADA guidelines require pool lifts that facilitate inde-
pendent usage. Independent usage is most facilitated
when hand controls are located at the front edge of
the seat, are within reach ranges compatible with
ADA technical specifications, can be operated with
one hand, can be operated with a closed fist, do not
require tight grasping, and can be operated with 5
118 Adapted Aquatics Programming

Photo courtesy of Aquatic Access, Inc.

Photo courtesy of G. William Gayle

Figure 6.5  A water-powered lift from Aquatic Access. Figure 6.6  This permanent lift takes up little deck space.

pounds (2.3 kilograms) or less of force. Lifts require

little deck and pool space, but should stay in place to
provide easy access and to reduce the risk of damage
that comes from constantly moving them. They vary
in price from approximately 900 to thousands of U.S.
dollars. The most elaborate lift costs $12,000 U.S.
and actually lifts the entire wheelchair into the water.
Most lifts require some type of pool deck modifica-
tion. Some decks, however, have a permanent sleeve
with a portable lift. When using a removable device,
you must leave it in place until all participants have
exited the pool. When the lift is not in place, a sign
must be posted instructing potential users on how to
ask for assistance with the lift (National Center on
Accessibility, 1996).
When discussing whether your facility should have
a movable or permanent lift, your facility staff and
pool operator must address the following concerns:

• Is the pool outdoors? If so, the exposure to the

sun, wind, and rain can diminish the overall life
of the equipment (Ostby & Skulski, 2004).
• Is there a possibility of a risk management issue
due to the lift being an attractive nuisance? Is
there a good chance people will use it in an
unauthorized manner? Figure 6.7  Portable devices may take up excessive
deck space, yet provide access in a variety of locations.

• If the lift is permanent, will it be exposed to
chemicals and humidity that may compromise
its integrity?
• Do you have a lot of temporary staff? If the lift
is movable, will all staff know how to safely
install it and perform all the associated safety
checks?
• Will people with disabilities really be inde-
pendent if the lift is movable? Is it desirable for
people who need the lift to have to ask for it to
be put in every time they want to swim?
• If the lift is battery powered, who will recharge
it for ready use?
• What are the implications for constantly remov-
ing and reinstalling the lift in terms of constant
handling and finding storage in a place that
does not compromise its structure (i.e., not the
corner of the closet with other equipment piled
on top of it)?
A person with a disability should be able to access
the pool as independently as possible. “Waiting until
someone requests the use of the lift to install it draws
unwanted attention to the user, mitigates their inde-
pendence, and forces the user to rely on pool staff to
enter the water. Conversely, a permanently installed
lift enables the user to enter the water independently
and without drawing attention” (Ostby & Skulski,
2004). Pool managers and staff members must look
closely at their facility and their patrons to determine
whether they should provide a temporary or perma-
nent lift for the facility. Most lifts can be purchased
with a kit that allows for transporting the lift when
necessary.
Ramps, Stairs, and Ladders
Portable ramps, stairs, and ladders are specifically
fit to match the water depth and deck proportions of
each pool. Typical materials are stainless steel, PVC,
and fiberglass. Figure 6.8 depicts portable stairs that
fit flush against the wall and floor in the corner of the
pool. These portable steps serve anyone who cannot
effectively negotiate a vertical, in-wall ladder. Por-
table pool steps must meet the criteria for accessibility
listed under the ADA. They should be slip resistant,
be uniform in height, have handrails, and have treads
no less than 11 inches (27.9 centimeters) deep. If
the pool has a sloped entry (sometimes called a wet
ramp), movable floor, or zero-depth entry to provide
accessible entries and exits, an aquatic chair with
push rims should be provided. Aquatic chairs come
in various styles with various attachments. Shower
chairs made of PVC pipes and a plastic seat like a
Facilities, Equipment, and Supplies 119
Photo courtesy of Shawn Stevens
Figure 6.8  Portable stairs jut out into lane space but
may be removed when not needed, such as when a
swim team uses the pool.
toilet seat allow for a person to remove his swimsuit,
have someone push the chair over a toilet, use the
toilet, be pushed into the shower, shower, and then
move into the changing area without getting out of
the chair. These chairs are not self-propelled, but may
have seat belts and wheel locks. It has been found
that the locks on the small wheel casters are virtually
useless, but with full assistance, this chair is useful
for people with severe physical disabilities who can
be assisted to the sitting position. The chairs are not
functional for a person with a severe disability who
needs a reclining chair or gurney-type device for pool
removal up a ramp. Shower chairs are often found in
a residential facility for people with disabilities and
must be disinfected following each use.
Most public pools have an aquatic chair that
resembles a standard manual wheelchair in looks but
is outfitted with stainless steel, mesh seating materi-
als, and a quick-drying seatbelt. These chairs range
in price from $300 to $800 U.S., and it is often nec-
essary to have more than one in the pool area when
conducting adapted aquatics programs.
Aqua chairs at the beach are a more common
sight now than they were a decade ago. All-terrain
wheelchairs with large inflatable tires help people
who use wheelchairs or cannot negotiate sandy areas
to explore new places, participate with peers, and
access oceans, rivers, or lakefronts.
120 Adapted Aquatics Programming
Transfer Systems
For individuals who have a strong upper body but
cannot negotiate stairs or ladders due to lower-
body involvement, a transfer system (figure 6.9) can
facilitate more independent pool access. A transfer
system is generally made of fiberglass or plastic and
consists of a transfer platform, a series of wide, short
steps that descend into the water, and short handrails.
A participant transfers from a wheelchair onto the
upper step and then lowers herself into the pool step
by step (U.S. Access Board, 2003). She reverses the
process to exit the pool. The transfer system requires
no facility renovation and can be removed and stored
on the deck when lap swims or other programs need
all the room in the pool, as the transfer system extends
into the pool about three-fourths of a lane. The steps
should feature nonskid tread strips, have no sharp
edges, and be nonabrasive. Clear deck space of 60
3 60 inches (152.4 3 152.4 centimeters) should be
adjacent to the surface of the transfer steps. “A trans-
fer platform shall be provided at the head of each
transfer system. Transfer platforms shall provide 19
inches [48.3 centimeters] minimum clear depth and
24 inches [61.0 centimeters] minimum clear width”
(U.S. Access Board, 2003). The transfer surface should
be 16 to 19 inches (40.6-48.3 centimeters) above
the deck. The maximum height of each transfer step
is 8 inches (20.3 centimeters), although a shorter
height is recommended. The tread depth should be
14 to 17 inches (35.6-43.2 centimeters) and the tread
should be 24 inches (61.0 centimeters) wide. The
last step into the water should be at least 18 inches
(45.7 centimeters) below the surface of the water,
and one handrail should be provided (U.S. Access
Board, 2003).
Figure 6.9  An Aquatek Transfer Platform from Rehab Systems, LLC.
Safety Equipment and Supplies
In addition to typical pool safety equipment and
supplies, such as shepherd’s crooks or reaching
poles, ring buoys, first aid kits, rescue tubes, and
backboards, gym mats and flotation mats are helpful
when individuals with disabilities use the pool. As
a safety enhancer, gym mats provide a cushion for
participants transferring from wheelchairs to the deck
and or boosting themselves out of the water. Trans-
fers, especially independent transfers, may require
an individual to lie face down on the pool deck and
drag the lower body over the edge, possibly causing
skin abrasions. Gymnasium mats placed on the deck
and slightly overhanging the pool edge enhance
safe transfers (see figure 6.10) (Nearing, Johansen,
& Vevea, 1995). Waterproof aquamats, made of
closed-cell foam, are helpful for individuals who
are having a seizure or need to rest after the seizure
has ended. A sturdy, colorful mat that can be used
for multiple water activities and as a seizure aid is
the Sprint Flow Through Mat. There is a child and an
adult size, with prices ranging from $55 to $75 U.S.
These mats are available through Sprint Aquatics at
www.sprintaquatics.com. Mats also provide safety in
the locker room. Most facilities do not have changing
tables for individuals who cannot sit on a locker-room
bench or who need to lie down for dressing. A mat
that is disinfected after each use can provide a safe
surface for individuals who need additional padding
and support in the changing area.
In addition to equipment, safety supplies must be
constantly checked and restored. Nonlatex gloves,
antibacterial wipes, tissues, and body fluid cleanup
kits are imperative to keep stocked for adapted aquat-
Photos courtesy of Rehab Systems, LLC

Photo courtesy of Shawn Stevens
Figure 6.10  A mat placed on the pool deck can   more severe problems in the article “PFDs for the
prevent bruises and abrasions from occurring during
transfers.
ics programs. Other items that might be helpful are
swim diapers and plastic pants with elastic legs in
a variety of sizes (which you can sell), extra towels
and sheets for using on deck during seizures, plastic
trash bags to put over the seat of a wheelchair when
no shower chair or aquatic chair is available, and
biohazard disposal bags.
Support Equipment and Supplies
Flotation devices, including personal flotation devices
(PFDs), water wings, pull buoys, wet vests, dumbbell
floats, and sectional rafts, give you an extra hand
when you are working with individuals who depend
on others to stay above the water (see figure 6.11).
Flotation devices can add an element of safety,
eliminate fear, provide support, and help participants
maintain a level position in the water (Heckathorn,
1980). Flotation devices should be selected to fit the
swimmer’s ability, range of motion, strength, buoy-
ancy, swimming style, and experience in the water
(Paciorek & Jones, 2001). There are flotation devices
for supporting the head (especially useful for swim-
Facilities, Equipment, and Supplies 121
mers with muscular dystrophy), full-body flotation
devices for swimmers with quadriplegia or severe
multiple disabilities, and handheld flotation devices
for assisting balance while water-walking. Flotation
devices also help keep the ears out of the water for
participants with serious ear problems. Specially
designed swimsuits by Speedo and other companies
provide in-suit inflation bladders to support the
swimmer. Because flotation devices help support,
stabilize, and facilitate movement, they may open
a new world to individuals with mobility impair-
ments, allowing freedom of movement not possible
on land. In addition to flotation suits, other devices
you might use under close supervision include swim
belts, bubbles, and squares, many of which come with
modules to increase or decrease flotation. Foam rafts
offer fun and relaxation as well as a central place to
play in the pool. They are more durable than blow-up
rafts and can support more weight. Water logs, also
known as water noodles or woggles, are hefty, flex-
ible buoyant logs that encourage water exploration
and fun kicking.
While flotation devices are useful, they pose sev-
eral problems for individuals with disabilities. For
example, they may impair independence if swim-
mers rely on them too long after they should have
progressed to unaided swimming. Dunn describes
Handicapped: A Question of Responsibility” (1981).
A research study by the University of Minnesota’s
Medical School at Duluth tested a variety of typical
PFDs and found them difficult to put on and fasten
on individuals with disabilities. In addition, the PFDs
did not help maintain a good surface position due
Photo courtesy of Monica Lepore
Figure 6.11  A variety of flotation equipment should be
maintained for safety, support, propulsion, and fitness.
122 Adapted Aquatics Programming
to variations in body buoyancy and density caused
by muscle atrophy, amputations, and decreased
bone density. Researchers found that standard PFDs
positioned swimmers with disabilities too far on the
back and did not keep the mouth far enough above
the water surface. Unfortunately, in the United States,
creating PFDs for swimmers with disabilities has not
been a priority. Due to the difference in body types
of people with disabilities, it is very expensive to
research this issue. There are several equipment com-
panies that have manufactured flotation devices for
individuals with disabilities. Most often these devices
are designed to provide a better position for swim
instruction and to act as a second set of hands when
the instructor is providing tactile, hands-on teaching.
“Flotation devices also serve therapeutic purposes by
providing optimal body position to facilitate relax-
ation as well as inhibiting inappropriate patterns of
movement” (Stopka, 2001a, p. 37). “When using
flotation aids, most of the flotation must center over
the lungs and upper chest, not around the stomach or
solely across the back” (Shurte, 1981, p. 2). For more
information, also read the discussion on buoyancy
in chapter 7.
A company from Canada, Life Jacket-Adapted
Inc. International, has shown promise in the design
of their life jackets, which are suited directly to the
needs of people with disabilities. Their motto, “Safe
and reliable life jackets designed for people of all
ages with reduced mobility,” depicts their commit-
ment to guaranteeing that all people will find a life
jacket to meet their needs. The Web site, www.pfd-
a.com, has helpful hints for selecting a life jacket
and asks for an individual’s body measurements and
behavior in the water in order to meet his needs more
specifically. There are two main models: the PFD-A
(Personal Flotation Device-Adapted) and the Lj-A
(Life jacket-Adapted). These jackets are designed for
people who do not have the survival reflex, cannot
right themselves to a face-up position, and cannot
control their body movements. All jackets are made
without latex and are designed for comfort and safety.
PFD-As are designed to keep water out of the user’s
nose, ears, and mouth and are supposed to keep the
body in a horizontal position even when body com-
position and stability vary due to severe disability.
PFD-As are designed to assist aquatic therapists and
adapted aquatics instructors. They meet Canadian
Coast Guard standards for keeping the body at the
level of the water surface.
The Lj-A is designed to keep the person upright
with the face out of the water and is used for persons
who can put themselves into an upright position in
the water. It is more of a safety device than a learn-
to-swim aid, but it allows swimming on the front as
well as on the back. The Lj-A is stable and supports
the head in a vertical position. It meets the “keeps the
head out of the water” standards by Transport Canada
and the International Safety of Life at Sea (SOLAS)
and the International Organization for Standardiza-
tion (ISO).
In addition to formal life jackets and PFDs, a variety
of other support equipment exists. Flotation devices
that increase relaxation, improve confidence, and
increase motivation do not make a program work,
but they do complement an appropriate instructional
program (Stopka, 2001a). Equipment for support and
buoyancy has conventional and nonconventional
uses. Conventional equipment such as jog belts, ski
belts, inflatable tubes, foam noodles, kickboards, and
flotation barbells can be used in many ways, such as
under each arm and leg, under the waist, behind the
neck, and under the chest or stomach. Additional
equipment from Sprint Aquatics has sprung onto
the market, such as the Sprint Flow Through Mat,
Burdenko Board, Sprint Wonderboard, and Sprint
Starboard. Other manufacturers and distributors of
unique flotation devices are Speedo, Finis, Aqua
Sphere, Swim Ways, Sportime, FlagHouse, and
Access to Recreation. Information about each of these
companies can be found in appendix E.
A longtime advocate of adapted aquatics is
Danmar Products, Inc. From the Delta Swim System
to the Sectional Raft and the Dolphin Float System,
Danmar has been a leader in the adapted aquat-
ics flotation industry since 1967. The devices are
specifically made for individuals with more severe
disabilities, but they can be adapted for people with
a variety of swim skills. These devices are extremely
durable and cost approximately $65 to $225 U.S. The
products do not contain latex and are all made of a
closed-cell polyvinyl foam.
Flotation devices come in many shapes, sizes,
and buoyancy levels. Some are approved for use in
watercrafts and actually put swimmers in an upright
or back-lying position. Some are approved by the
U.S. Coast Guard, and others are intended for sup-
porting a person during therapy or swim lessons. If
your participants use flotation devices for support, you
must provide proper supervision, even if the PFDs are
approved by the U.S. Coast Guard.
Propulsion Equipment
and Supplies
A swimmer’s forward movement in the water is
affected by physical ability, body shape, and effi-
ciency of swim stroke (Andersen, 1988). The first step
 Facilities, Equipment, and Supplies 123

to efficient propulsion is to devise flotation or other
support that puts the body in the most streamlined
and balanced position possible. If the participant still
has difficulty with propulsion, try other devices. Hand
paddles increase the surface area of the hands and
press against the water for propulsive efficiency, as
do fins; however, overusing hand paddles can cause
shoulder injuries. Other propulsive aids that are not
as harsh on the shoulder are Lycra or neoprene hand
mitts; depending on arm and hand strength, Lycra
offers less resistance than neoprene offers.
Prostheses designed for the water and fins that
directly attach to prosthetic sockets can be used by
swimmers with lower-body amputations (Marano &
DeMarco, 1984). Prostheses can provide propulsion,
even weight distribution, and balanced body position
in the water (Paciorek & Jones, 2001). Some examples
of prostheses included in Paciorek and Jones (2001)
are the Otto Bock Hollow Ultra Light, the Aqualite,
and the Activeankle (by Rampro). For specific ideas
for using these devices see Paciorek and Jones (2001)
and Summerford (1993).
State-of-the-art swim devices for people with limb
deficiencies or losses are manufactured by Thera-
peutic Recreation Systems (TRS), Inc. This Boulder,
Colorado, company manufacturers the Freestyle
Swimming Td. and the Swim Fin Kit. The Freestyle
Swimming Td. is used with a custom swimming pros-
thesis as a competitive swimming aid for individuals
with upper-limb amputations. The Swim Fin Kit is
used directly on the stump.
Chris Stopka (2001a) describes a swim fin adapta-
tion for people with lower-limb loss. Using an extra
mold of the residual limb (leg stump) attached into the
swim fin by waterproof tape provides the necessary
alteration for people with lower-body amputations to
increase propulsion.
Over the last few years companies have developed
dozens of equipment pieces and a variety of supplies
to facilitate fitness, and many of these are geared
toward water rehabilitation. Peruse equipment and
supply catalogs to compare prices and materials (see
appendix E).
Motivational Equipment
and Supplies
Most of us are familiar with frightened swimmers.
They do not want to enter the water, put their face
under, or make any movements that might upset their
precious equilibrium! Using motivational equipment
to create fun can provide a transition between expe-
riences that are frightening and activities that draw
attention away from being frightened and toward the
task at hand (Stopka, 2001a). Some individuals with
intellectual disabilities and attention difficulties must
be encouraged to pay attention and to find meaning
in an activity that seems strange or scary. Motivational
equipment and fun toys can bridge the transition from
caregiver to aquatics staff member and from one
activity to the next. Having fun and being distracted
by a pool toy or a colorful piece of equipment can
enhance motivation and success once safety issues
have been guaranteed.
Toys and other equipment provide a developmen-
tally appropriate addition to the pool environment
for children 6 months old through elementary school

Fitness Equipment and Supplies

The growth in the number of participants in water
fitness classes has increased the number of products
available for water fitness training. Underwater tread-
Photo courtesy of Excel Sports Science, Inc.

mills, aquacycles, water workout stations, and aquatic

exercise steps provide cardiovascular conditioning,
muscle toning, and strength training. Water fitness
participants also use supportive and resistive devices
in the water that are handheld, pushed, or pulled, such
as finger and hand paddles, balance bar floats, upright
flotation vests and wraps, aqua shoes, webbed gloves,
waterproof ankle and wrist weights, workout fins,
buoyancy cuffs, ski belts, aqua collars, and jogging
belts (see figure 6.12). Encourage participants to use
caution with hand paddles, as they may contribute to Figure 6.12  An AquaJogger belt can provide vertical
shoulder injury if overused or improperly used. support in the water.
124 Adapted Aquatics Programming
Photo courtesy of Monica Lepore
Figure 6.13  Children’s equipment should be safe and
bright and have many uses.
age. The developmental levels, interests, and atten-
tion spans of children require a different approach
to aquatics instruction and recreation than that used
with teens and adults. Attractive, brightly colored
equipment, nontoxic and sturdy supplies, toys, flota-
tion devices, and balls will help you devise instruc-
tional strategies that focus on fun. In addition, hoops,
inner tubes, diving rings, disks, water basketballs,
goggles, fins, nose clips, and swim caps are useful
(figure 6.13).
The Wet Wrap by D.K. Douglas Company is a wet
suit vest to wrap around the body for added warmth;
it can be used with both adults and children (see
appendix E). In multipurpose pools in which the water
temperature is less than 85 °F (29.0 °C), the Wet Wrap
and its partner, Wet Pants, is useful for participants
with poor internal heat production systems, people
with low body fat (as is often the case for individuals
with cerebral palsy), and children who don’t move
enough to keep warm. The Wet Wrap is easy to put
on, as it does not have to be pulled over the head.
There is some unconventional equipment that you
may want to try in an adapted aquatics program. In
a series of articles in Palaestra, Chris Stopka (2001a,
2001b, 2001c) showed equipment uses that stimu-
late creative thinking. Gymnastics mats can serve
as floating docks; desks, tables, and metal benches
can serve as water tables to rest or jump from; and
PVC bars made into parallel bars can serve as mobil-
ity aids as well as assist in the floating process (see
figure 6.14).
Storage of Equipment
and Supplies
You should have sufficient supplies available to
safely conduct the adapted aquatics class. Advanced
planning by instructors simultaneously using the
supplies is critical to instructing without delays and
to accounting for equipment at all times. Valuable
instruction time is often lost when equipment is in
disrepair, suddenly borrowed by another instructor,
or lost in storage.
To prevent these problems, at regular intervals
mark and remark all equipment and supplies with
an indelible marker. Maintain an accurate inventory
of all equipment and supplies in storage and make it
available to every instructor. Expect a reasonable turn-
over of equipment, and reflect your expectations in
replacement schedules. Restrict use of equipment to
classes and organized recreation programs, avoiding
the damage and loss that inevitably result from use in
open recreation and activities by outside groups.
Establish a system for the storage, repair, and issuing
of equipment and supplies. Label shelves and bins,
and ensure appropriate ventilation to prevent mildew-
ing. Insist that all instructors and participants accept
responsibility for the care and storage of equipment.
Use large traffic cones for swim rings and tire tubes for
seats on the deck (Stopka, 2001b). Tightly enclose a
large group of noodles through several hula hoops and
suspend from bungee cords from the ceiling or in the
coat closet. Use an old portable coatrack on wheels
to hang ski belts, jog belts, PFDs, and vests.
Finally, designate an additional area for storing
wheelchairs, crutches, canes, and braces and a dry
area for leaving hearing aids and cochlear implant
discs during class times. Storage for mobility devices
such as a white cane and an area for service animals
communicate to patrons who are blind that your
organization wants to make swimming available
to them. Designated areas for mobility devices and
assistive technology will keep the deck free of objects
that could possibly impair the mobility of participants
if left lying around.
Summary
Although your knowledge, skills, and attitudes are
the most important aspects of your adapted aquatics
program, the facilities, equipment, supplies, and stor-
age play a critical role in the comfort, safety, support,
and, ultimately, achievements of your participants.
Fortunately, physical barriers to participation in
aquatics programs by individuals with disabilities are
 Facilities, Equipment, and Supplies 125

Figure 6.14  Balance practice is fun on the Flo Through Mat by Sprint Aquatics.

disappearing as architectural barriers are removed
and technology develops to better support individual
needs. As these barriers disappear and adapted facili-
ties, equipment, and supplies become more widely
available, individuals with disabilities are afforded
more opportunities to participate with individuals
without disabilities. If your program uses equipment
and supplies appropriately and modifies existing
facilities, it will help participants with disabilities
transition into more inclusive recreational and edu-
cational settings, such as community pools, lakes,
oceans, and general aquatics programs.

Chapter 6
Review 1. List the two primary means of pool access according to the ADAAG.
2. List five secondary means of pool access according to the ADAAG.
3. Why are individuals with disabilities and weak immune systems more sus-
ceptible to infections when swimming in high water temperatures?
4. What pool procedures should you follow after fecal or vomiting incidents?
5. Discuss the basic reasons for using adapted equipment and supplies in
adapted aquatics programs.
6 What is accessibility?
7. What are pool deck features that are more user friendly to patrons with
disabilities?
8. Discuss water quality and temperature issues related to pool water quality
and individuals with disabilities.
9. Discuss the pros and cons of using flotation devices with swimmers with
disabilities.
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 Part II

Facilitating
Instruction

127
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 7
Prerequisites to Safe,
Successful, and
Rewarding Programs

C arla learned to swim at an early age and developed into a water rat. She
participated in an ever-expanding world of aquatic activities until her life’s
path was altered due to a spinal cord injury sustained in an automobile accident.
After her rehabilitation, she decided to move her life forward and enrolled in a
local state university. One day Carla’s roommate discussed Carla with her univer-
sity water aerobics instructor. They approached Carla about joining their class as
a means to reconnect with her favorite activity and to increase her socialization.
Carla resisted with a list of excuses including her disability, body image in the
locker room, and perception that everyone would stare at her in the pool due
to her disability and hygiene appliances. The instructor showed her the changing
room for people with special needs and allowed her to simply observe the class.
She felt comfortable with an alternate changing area and soon discovered that,
due to the buoyancy of the water, she could perform many of the movements
performed in class. With her instructor’s encouragement, combined with architec-
tural and program accessibility, she began to participate in campus recreation
and community swimming and water-related activities. She continues to take on
new challenges and confronts the future as opposed to dwelling on the past.

129
130 Adapted Aquatics Programming
A s the aquatics teacher, you play a critical role in
the success of the adapted aquatics program. In
this chapter, we focus on the essential knowledge and
skills that are necessary for conducting programs in
which individuals with disabilities learn to feel safe,
comfortable, and confident.
The most important skill—and the foundation
on which all progress rests—is the ability to com-
municate. You must know how to connect mentally,
physically, and emotionally with participants in order
to develop relationships that are based on trust. For
example, your first opportunity to establish trust and
rapport may occur when you assist a participant with
activities of daily living such as undressing and toilet-
ing. Knowing how to respectfully approach and assist
an individual who is struggling with incontinence,
for example, may make the difference that allows
the individual to feel relaxed enough to participate
in rather than watch the first session.
In addition to possessing communication skills,
you must thoroughly understand proper participant
positioning, guiding, and supporting. The art and
science of assisting participants during all parts of
the aquatic experience are crucial to the learning
process and to building confidence. Participants will
expect you to give clear instructions and to provide
assistance whenever they need it to correctly perform
an activity. Thus, you must understand hydrodynamic
principles in order to appropriately give feedback.
Other fundamentals in developing successful
programs are participant safety, personal care, and
behavior management. It is vital that you are well
trained in each of these areas so you can provide
persons with disabilities the individualized care they
require in a safe, secure environment.
Chapter Objectives
From this chapter, you will learn the
following:
* Communication skills facilitate initial con-
tact, encourage respect, and empower
the participant.
* Safe and successful transferring encom-
passes knowledge of general rules, body
mechanics, and both dependent and
independent transfers.
* Participant care and safety involve
safety procedures in locker rooms,
shower areas, and family changing
rooms.
* The hydrodynamics of water affect the
human body and thus influence your
instructional approach.
* Providing physical assistance to indi-
viduals with disabilities is very personal,
requiring profound respect for all partici-
pants.
Essential Communication Skills
Moving a lesson from the paper to the pool requires
you to interact with the participants and the envi-
ronment. Interactive skills are especially important
when providing aquatics instruction to individuals
with disabilities. Your awareness of the needs of each
individual, along with a no-pity attitude, provides the
basis for a relationship.
While the instructor–participant interaction does
not solely deal with verbal communication, your
words, voice inflection, and tone can greatly enhance
or detract from interaction. How do you know if you
are using an appropriate approach? Have someone
observe you as you interact with the group and then
answer the following questions: Do you use sentences
that are geared below the participants’ mental or
social ages due to low expectations of individuals
with disabilities? Are you aware of other group inter-
actions? If a participant needs constant redirection,
can you attend to two events simultaneously? Do you
interact with all participants with the same intensity
and motivation irrespective of disability? Do you
provide an emotionally safe atmosphere in which
you discourage teasing, flippant remarks, and subtle
derogatory behaviors? Do you encourage individuals
with disabilities to contribute?
We all send verbal and nonverbal messages
through oral, signed, or written language as well as
through body language, gestures, and facial expres-
sions. Of course, some forms of communication are
more effective and positive than others. Effective com-
munication skills are important for participant safety,
learning, and enjoyment. Establishing excellent com-
munication with participants and significant others
is important from the very first meeting. Overcoming
communication barriers facilitates safe, effective, and
relevant aquatic experiences for all involved.
Each aquatics instructor has a distinctive manner
in which he seeks harmony with a group. When you
can pinpoint your own interactive repertoire, you can
begin to improve your techniques. If participants with
disabilities do not receive an opportunity to respond

to questions and challenges or have adequate practice
opportunities, they will not venture beyond their cur-
rent repertoire of skills, and thus your communication
will limit the growth of their aquatic skills. So talk
frequently to the participants and their significant
others in order to become comfortable with each
individual’s interactive limitations and to learn how
to create more positive interactions. In addition to
interacting positively, implement all the elements of
effective instruction in order to make the aquatics
session safe, effective, and relevant for an individual
with diverse learning needs and abilities.
Establishing Initial Communication
Beginning with the first meeting, never underestimate
the importance of effectively communicating with
the individual you’re instructing. Any activity that
permits shared planning can promote communication
building. Begin by discussing the program, learning
about the participant, and going over what each of
you should expect from each other. Foster a strong
relationship right from the start by working together
as equals to plan a program. If the participant is too
young or has a cognitive impairment that limits her
ability to plan for the future, then invite significant
others to help with the planning.
Becoming Comfortable With Equipment
To develop a positive relationship, become familiar
and comfortable with all the equipment the partici-
pant uses. Clumsily transferring a participant at the
first meeting, for example, will not get your relation-
ship off to a good start. Therefore, practice procedures
and familiarize yourself with transfers, braces, lifts,
internal or external catheters, ostomy pouches, and so
on, well in advance of the initial pool session. Such
efforts will lead to more comfortable interactions
during initial swim sessions.
Overcoming Hesitation
Initially, an individual with a disability may hesitate
to communicate with you. A lack of aquatic experi-
ences, a fear of failure, the newness of a disability, or
an apprehension caused by new people and places
can all initially hinder communication. To overcome
a participant’s hesitancy, make him feel welcome.
Walk or wheel around the pool area, pointing out
interesting people and features of the pool facility.
Introduce the participant to others, demonstrate
how the lift works, and point out participants who
have been successful. Let him chat with one of the
program participants who is upbeat; doing so is a
great motivator.
Prerequisites to Safe, Successful, and Rewarding Programs 131
Answering Questions
Be patient with questions that a participant or care-
giver may have. Distribute a typed sheet with pro-
gram information and answers to commonly asked
questions. Provide your contact numbers, the phone
numbers of others in the program, and the number
of the pool office. Have a pen or pencil handy with
a clipboard so the participant or caregiver can jot
down additional notes of interest on your information
sheet. If the person cannot use her hands to write or
has a poor memory, take a portable cassette player
to record the orientation with important information
so that the participant may review your introduction
at a later date.
Showing Respect
No matter how severe a person’s physical or mental
disability is, shake or touch the participant’s hand in
greeting. Bend down or sit at the physical level of
the participant and talk directly with him instead of
directly with the caregiver. Speak loudly enough for
the caregiver to hear but direct conversations to the
participant. Stand close to the participant and offer
help if necessary during the tour and discussion.
Remember that nonverbal language is as important
as verbal language. Standing far away with your
hands on your hips or your arms crossed during a
discussion may alienate the participant. Standing
over a person in a wheelchair and looking down at
her might convey the nonverbal message that the
participant is inferior.
Empowering the Participant
Always remember that each participant is a person—
not a disability. Look for ways to empower each
individual. After giving the tour, answering questions,
and discussing the goals, activities, and skills that you
should assess, offer a chance to swim. Some individu-
als may be comfortable getting into the water at this
point, while some may need to observe a few sessions
before actually getting into the water. Be patient; keep
in mind that many individuals have not swum in a
long time and a few may never have been in a pool.
Fear of water, of failure, or of an inability to control
the body in this new environment may make an indi-
vidual reluctant to swim. Respectfully acknowledge
these natural emotions and allow the participant to
decide when he is ready to enter the water.
In a further attempt to empower a new partici-
pant, consider requesting that she come to the first
or second meeting with a prioritized list of aquatic
activities that she would like to accomplish. While
assessment may dictate that you modify this list, the
132 Adapted Aquatics Programming

participant will feel more at ease during assessment, express or interpret language), dysarthria (poor ability
knowing that she will be doing some activities of her to articulate), and problems with tone, inflection, and
own choosing. volume. Participants who have sustained facial injury,
traumatic brain injury, or stroke or who have been
Developing Trust and Rapport diagnosed with pervasive developmental disabilities
or severe mental retardation may be unable to speak
As you show respect for the individual with disabilities,
or effect facial expressions at all. Since facial expres-
you will begin to develop trust and rapport that, with
sions and intonation are significant elements of com-
careful attention on your part, will continue throughout
munication, it may be difficult for you to determine
the life of the relationship. Building trust and rapport
if such a participant is calm, anxious, fearful, happy,
depends on honesty, commitment, and integrity. There-
or unhappy.
fore, be honest about your experience and abilities
You can overcome some of these barriers by care-
in adapting aquatic activities, be committed to the
fully observing participants to determine their pre-
participant and the program even when difficulties
ferred method of communication and to help develop
arise, and demonstrate integrity by following through
specific strategies for adapting communication in the
on decisions and promises. In addition, foster trust by
pool. Ask participants to repeat anything they say
being sensitive in your use of language. Language that
that you don’t understand and ask others who spend
is people first, and current, positively affects rapport.
more time with them to help translate. Some people
For example, using phrases such as “individuals with
use hand gestures, pointing, word or letter boards,
cerebral palsy” instead of “those CPs” and “people
eye movements, and speech to let others know what
with disabilities” rather than “handicapped people”
they want or need. Alternatives to communicating
shows sensitivity toward participants.
by speech and facial expressions may be necessary,
Performing proper methods of transferring, touch-
however. Adopt alternative strategies for overcoming
ing, and supporting participants in the locker room,
barriers to meet the needs of each individual. Use the
on the pool deck, and in the pool will also help to
list in the sidebar on this page to get started.
develop relationships that are based on trust. Asking
Good communication enhances safety. Through
participants or caregivers about successful methods of
it you will know, for example, when a participant
assisting rather than just assuming that one way is best
is cold, uncomfortable, or in pain. Communicating
can help the participant and caregiver feel in control
with professionals and significant others will help
of the situation. Knowing how to use all the adapted
equipment, wheelchairs, and flotation devices pro-
vides an atmosphere of efficiency and safety that
makes everyone feel comfortable. Likewise, holding
Strategies for
someone with a firm and balanced grip that is as
close as safety and comfort allow communicates care Overcoming
and establishes trust and rapport. For more specific Communication
information on positioning and holding, see related Barriers
sections later in this chapter.
❚ Give a thumbs-up or thumbs-down for
“yes” or “no.”
Overcoming Communication
Hang laminated word or letter boards
Barriers ❚
from the pool edge.
Just as an individual’s aquatic skills may vary, so does ❚ Place chalk and a small slate near the
the individual’s ability to communicate. To be effec- pool edge.
tive, along with performing the aquatic assessment ❚ Use sign language.
you must be able to assess an individual’s commu-
❚ Enhance communication by being
nication abilities and to respond to each person at patient.
the appropriate level. Difficulties in communicating
❚ Have caregiver or significant other stay
may stem from oral muscle dysfunction, scarring from
nearby for help translating.
traumatic injuries or surgery, mental retardation or
❚ Never say you understand if you don’t.
other cognitive impairment, and damage to the brain
in the areas governing emotion or language. Common ❚ Share your goals and plans with the par-
deficiencies in speech and language include apraxia ticipant, using a simple format for people
with severe disabilities (Lepore, 1991).
(problems with motor planning of speech), expres-
sive and receptive aphasia (impairment of ability to

you avoid contraindicated activities and medical
emergencies. Significant others may reveal behav-
ioral and physical problems that might be potentially
dangerous. They may share behavior modification
programs, increasing your effectiveness as a teacher
by increasing consistency. Work hard to overcome
communication barriers to create an individualized
program that is more relevant to and safe for the
participant.
Transferring Techniques
A transfer is the moving of a participant from one
surface to another or from one object to another
by means of a specified pattern of safe and efficient
movements. Transfer activities include movements
from the wheelchair to the pool deck, to the lifts or
hoists, to the toilet, or to the shower chair and vice
versa. The ADA mandates that using manual transfers
as the sole means of providing access is unaccept-
able. However, manual transfers may be appropriate
alternatives for accommodating participant prefer-
ences or comfort and for implementing emergency
procedures. In addition, safety concerns, appropriate
physical support, and specific functional abilities of
the participant may also warrant manual transfers.
General Rules of Transfer
Transferring in and out of a manual or electric wheel-
chair is potentially dangerous and therefore requires
the maximum attention of all people involved. The
safety of the participant and lifters is paramount;
the proper use of body mechanics reduces the pos-
sibility of injury. Keep in mind that individuals with
disabilities represent an extremely heterogeneous
group; therefore, no one generic transfer technique
can accommodate all participants and settings. You
must properly assess the participant and the environ-
ment using your up-to-date knowledge of transfer-
ring techniques and disabilities. Before undertaking
a transfer, analyze and organize the answers to the
following questions:
• Can you teach the participant to transfer inde-
pendently?
• Can the participant explain how to perform
the transfer?
• Have you discussed with the participant and
caregivers how the participant will help and
cooperate during the transfer?
• If the participant requires assistance, are com-
petent aides available?
Prerequisites to Safe, Successful, and Rewarding Programs 133
• Have you informed the aides of their roles and
designated who is in charge?
• Do the aides understand their roles and the
group goal?
• What will be done, and what is the easiest
method for doing it?
• What equipment does the participant need, and
have you checked the required equipment for
proper function and safety?
• Is the transfer area set up and have obstacles
been removed?
• Are hands positioned on the participant and
equipment properly?
Either ask the participant to explain her preferred
method of transfer or explain the steps required to
execute a transfer to her, ensuring that she under-
stands your expectations. Use commands and counts
to synchronize the actions of all people involved in
the transfer. When more than one person must assist
the transfer, designate one lifter to give commands.
This primary lifter should explain how the count will
be given—for example, “I will count to three and then
give the command to lift. When I say lift, we will lift.
One, two, three, lift.” The lifter giving the commands
should always check visually and verbally to ensure
that all individuals are ready before the team attempts
the transfer. Once the transfer seems to be complete,
the primary lifter should make sure that the participant
is positioned correctly and is comfortable and that all
lifters are ready to relinquish their holds.
Basic Body Mechanics
Good body mechanics are essential to performing a
task efficiently and safely. The following principles
will help promote good body mechanics (Heller,
Forney, Alberto, Schwartzman, & Goeckel, 2000;
McSwain & Paturas, 2001; Rantz & Courtial, 1981):
• When lifting and carrying, keep the load close
to your body and well balanced.
• Carry your load at a comfortable height.
• Use your legs and hips for lifting.
• Keep your back straight when working and
lifting.
• Avoid twisting the trunk of your body when
lifting and carrying.
• Plan your actions in order to best use the lever-
age provided by your trunk and legs.
• Stand with one foot forward to give a wider
base of support.
134 Adapted Aquatics Programming

• Remove any equipment parts that will hinder
the transfer, such as armrests, footrests, or
abduction pommels.
• Unfasten the participant’s seat belt and any other
safety straps (e.g., chest straps, foot straps).
Dependent Transfers
Transfers requiring minimal or no active involvement
by the participant are called dependent transfers.
Dependent transfers include the two-person standard
lift (pages 134-136), the two-person through-arm
lift (pages 137-138) (the more dependent transfers),
the standing pivot transfer (pages 138-139), and the
sliding board transfer (the less dependent transfers)
(pages 140-141). See also the description of depen-
dent transfers using a mechanical lift on pages 141
and 142.
If the participant has limited mobility or is very
large, you’ll need a minimum of two people for a safe
transfer. Participants who have some upper- or lower-
body strength may be willing to assist in the transfer.
When this is the case, the standing pivot transfer and
the sliding board transfer may be the most successful.
The sliding board transfer is also useful in situations
in which the individual is too large for the lifters to
move safely. When appropriate, make it your goal
to gradually reduce the amount of assistance the
participant needs until he can perform the transfer
as independently as possible.

Two-Person Standard Lift—Wheelchair to Pool Deck

1. Lifters ask participant about preferences or explain transfer procedure to participant
(see figure 7.1a).
2. Lifters position wheelchair parallel or at a slight angle to transfer spot.
3. Lifters lock brakes on wheelchair.
4. Lifters remove footrests and armrests and place under wheelchair.
5. Lifter 1 (primary lifter) and lifter 2 stand on each side of participant, facing each other
with feet apart, knees bent, backs straight, and heads erect (see figure 7.1b).
6. Participant places one arm around each lifter’s upper back.
7. Lifters place one arm under participant’s thighs as close to hips as possible.
8. Lifters grasp each other’s hands by one of the following methods: single-wrist grip,
double-wrist grip, finger grip, or double-hand grip (for individuals with good upper-
body control).
9. If lifters use either single-wrist grip or finger grip, their other hand should support the
participant’s back, shoulders, or neck.
10. On command by lifter 1 (primary lifter), lifters straighten their knees and hips (using the
legs, not the back) and move participant toward transfer spot (see figure 7.1, c-d).
11. Lifters carefully lower participant to deck, contacting participant’s buttocks squarely
on deck, legs perpendicular to water (see figure 7.1e).
12. Lifter 2 enters water and moves participant’s legs around so that they hang over the
pool edge from the knees.
13. Lifter 1 continues providing trunk support (see figure 7.1f).

(continued on page 136)

Figure 7.1a  Two-person standard lift. Discuss transfer Figure 7.1b  Emphasize correct body position of partici-
with participant. pant and lifters.

Figure 7.1c  Stand in unison with other lifter, using verbal Figure 7.1d  Verbally communicate to initiate move-
count. ment.

Figure 7.1e  Use legs when lowering participant. Figure 7.1f  Continue trunk support.

135
136 Adapted Aquatics Programming

14. Lifter 2 reaches up, supports participant under shoulders, and lifts participant into
water, while lifter 1 continues trunk support (see figure 7.1g).
15. Lifter 2 sits participant on her (the lifter’s) thighs or lays participant on back (see figure
7.1h).

Figure 7.1g  Support participant under arms. Figure 7.1h  Balance participant on lifter’s thighs.
 Prerequisites to Safe, Successful, and Rewarding Programs 137

Two-Person Through-Arm Lift—Wheelchair to Pool Deck

1. Lifters begin with steps 1 through 4 presented for the previous lift (the two-person
standard lift for wheelchair to pool deck).
2. Lifter 1 stands behind participant, while lifter 2 stands beside participant, facing the
transfer spot.
3. Lifter 1 asks participant to sit upright and cross arms in front of trunk.
4. Lifter 1 reaches under participant’s arms and grasps wrists (see figure 7.2a).
5. Lifter 1 places one foot on either side of wheelchair’s rear wheel and leans around
vertical back frame of wheelchair (see figure 7.2b).
6. Lifter 2 places arms under the participant’s thighs and calves for support (Turner,
1987).
7. On command of lifter 1 (primary lifter), lifters lift and move participant to transfer spot
(see figure 7.2c).
8. Lifters continue steps 11 through 15 of previously described lift, the two-person stan-
dard lift for wheelchair to pool deck (see figure 7.2d).

Figure 7.2a  Two-person through-arm lift. Grasp wrists Figure 7.2b  Position participant.
and support knees.

Figure 7.2c  Verbally communicate and initiate move- Figure 7.2d  Continue sitting support during transition to
ment. pool.
138 Adapted Aquatics Programming

Two-Person Through-Arm Lift—Pool Deck to Wheelchair

1. Lifters begin with steps 1 through 4 of previously described two-person standard lift
for wheelchair to pool deck.
2. Lifter 1 asks participant to sit upright and cross arms in front of trunk.
3. Lifter 1 (primary lifter) squats behind participant, while lifter 2 squats beside participant,
facing the wheelchair.
4. Lifter 1 reaches under participant’s arms and grasps wrists, while lifter 2 places one
hand under the participant’s thighs and calves for support.
5. On command of lifter 1, lifters lift participant (using legs, not back) to a height that
will clear all parts of wheelchair.
6. Lifters move toward wheelchair and stop once the participant is centered over wheel-
chair seat.
7. Lifter 2 gently pulls participant away from the back of the wheelchair to clear the verti-
cal wheelchair back.
8. Lifters place participant in wheelchair seat.
9. Lifter 1 may lean participant forward to check spine for red marks or lesions.
10. Lifter 2 provides towel for warmth, secures seat belt, and straightens clothing.
11. Lifter 1 never releases contact with participant until balance is secured.
12. Lifters return armrests, footrests, and feet to appropriate positions.

Standing Pivot Transfer

1. Lifter begins with steps 1 through 4 of previously described two-person standard lift
for wheelchair to pool deck.
2. Lifter stands in front of participant.
3. Lifter moves buttocks of participant forward in wheelchair to facilitate clearing the
wheelchair’s wheels.
4. Lifter places feet and knees outside the participant’s feet and knees while maintaining
a comfortable base of support.
5. Lifter stands in a semicrouched position in front of the participant.
6. Lifter places one hand at the base of neck if neck support is required and other hand
around trunk, or places both arms around rib cage or waist of participant and locks
both hands (see figure 7.3a).
7. Lifter synchronizes forward and backward rocking motion with participant during count
of three.
8. Lifter leans back, straightens legs, and lifts participant from chair on count of three (see
figure 7.3b).
9. Lifter lifts participant only as high as necessary to clear wheel.
10. Lifter pivots toward transfer target, rotating participant toward target (see figure
7.3c).
11. Lifter lowers participant into sitting position (see figure 7.3d).
12. Lifter never releases contact with participant until balance is secured.
13. Lifter has an aide remove wheelchair and components from transfer area.
Figure 7.3a  Standing pivot transfer. Position yourself Figure 7.3b  Support participant.
and participant.

Figure 7.3c  Communicate, initiate movement, and Figure 7.3d  Slowly lower participant while maintaining
rotate toward target. balance.

139
140 Adapted Aquatics Programming

Sliding Board Transfer

This transfer is used when the individual has good trunk and upper-body control but cannot
perform an independent transfer or wants to transfer to a spot level with the wheelchair.
1. Lifter follows steps 1 through 3 of previously described two-person standard lift for
wheelchair to pool deck.
2. Lifter removes footrests and places under wheelchair (see figure 7.4a).
3. Lifter asks and helps participant to move to front of chair.
4. Lifter removes armrest on transfer side and places under wheelchair.
5. Lifter asks and helps participant lean away from sliding board so that hip and buttock
on side of transfer are raised.
6. Lifter places sliding board under raised hip and buttock.
7. Lifter asks or assists the participant to place fist or palm flat on the sliding board while
placing the other hand on the armrest or seat (see figure 7.4b).
8. Lifter asks and helps participant to perform transfer by performing a series of push-ups,
lifting or sliding body while straightening arms and depressing shoulders (see figure
7.4c).
9. Lifter waits patiently while participant slowly moves toward target spot.
10. Lifter spots for balance by maintaining contact with participant’s shoulders.
11. Lifter removes sliding board once participant reaches target.
12. Lifter never releases contact with participant until balance is secured (see figure
7.4d).

Figure 7.4a  Sliding board transfer. Remove wheelchair E3344/Lepore/fig.7.4b/278500/pulled-alw/r1

Figure 7.4b  Place sliding board under transfer-side hip.
E3344/Lepore/fig.7.41/278499/pulled-alw/r1
components and position participant.
 Prerequisites to Safe, Successful, and Rewarding Programs 141

FigureE3344/Lepore/fig.7.4c/278501/pulled-alw/r1
7.4c  Spot as participant initiates movement. E3344/Lepore/fig.7.4d/278502/pulled-alw/r1
Figure 7.4d  Continue to make contact and spot until
balance is secure.

Hydropowered Lift Transfer

(transitional step between dependent and independent transfer)
1. Participant positions walker parallel or at a slight angle to lift seat.
2. Participant locks brakes on walker.
3. Assistant 1 asks participant about preferences or explains transfer procedure to par-
ticipant.
4. Assistant 1 (on deck) and assistant 2 (in water) position themselves to spot participant.
5. Assistant 1 grasps left hand of participant while participant places right hand on lift
chair seat.
6. Assistant 1 then gives participant support to initiate stepping for transfer to seat.
7. Assistant 1 explains lift operation, places left hand on participant’s trunk to maintain verti-
cal sitting, and visually checks participant’s seat belt and foot placement (figure 7.5b).

Figure 7.5a  Hydropowered lift transfer. Discuss level of Figure 7.5b  Participant secures seat belt and places
assistance with participant, and provide support. feet on foot plate.
142 Adapted Aquatics Programming

8. Assistant 1 engages hydropowered lift to swing around and lowers the lift into the
pool.
9. Assistant 2 converses with participant, limiting participant anxiety and preventing
increased muscle tone and trunk or leg extension (figure 7.5c).
10. Assistant 2 places hands under participant’s shoulders.
11. Participant grasps chair seat bar and moves to standing position.
12. Assistant 2 then explains next activity (figure 7.5d).

Figure 7.5c  Participant is lowered into water with aide Figure 7.5d  Support and assist participant according to
waiting. individual needs.

Independent Transfers Don’t let the participant become discouraged;

Independent transfers are performed as completely
as possible by the participant and therefore require
the participant to have significant strength, balance,
and functional ability. Although these transfers may be
difficult to learn and require practice to master, they
encourage independence, which in turn promotes
self-esteem. Which transfer should a participant use?
The answer depends on the participant’s preference,
muscular strength, trunk stability, arm length, and
functional use of hands and arms.
rather, encourage the participant to continue practic-
ing the chosen transfer. Become highly knowledge-
able of the independent transfer techniques described
on the following five pages, so that you may help each
participant maximize his independence, thereby facil-
itating uncompromised use of community swimming
pools during leisure pursuits. Use the task analyses of
transfers to direct a participant (see pages 143-147).
 Prerequisites to Safe, Successful, and Rewarding Programs 143

Transfer From Wheelchair to Pool Deck

1. Instruct participant to position the wheelchair next to transfer spot, not pool edge.
Instructor or aide should place a mat there for comfort and safety.
2. Instruct participant to lock brakes, or have aide secure wheelchair, and remove foot-
rests.
3. Instruct participant to move buttocks to edge of seat and position feet slightly back.
4. Instruct participant to grasp armrest or wheelchair seat rail with one hand and place
a hand on the floor approximately where the knees will land (see figure 7.6a).
5. Instruct participant to place the other hand on the floor as well (see figure 7.6b).
6. Instruct participant to rest on all fours, bearing weight on hands and arms, leaning
forward, and preventing knees from contacting the mat with too much force (see figure
7.6c).
7. Instruct participant to move one hand out to the side, controlling hips and lying on
the side of the body (see figure 7.6d).
8. Instruct participant to swing legs around so that they hang over pool edge at the knees
(see figure 7.6e).
9. Instruct participant, depending on swimming ability, to either roll onto stomach and
slide into shallow water or perform a sitting dive into water of safe depth (see figure
7.6f).

Figure 7.6a  Transfer from wheelchair to pool deck. Figure 7.6b  Participant places second hand on mat.
Lifter stabilizes wheelchair and participant positions body
with one hand on mat.
 Figure 7.6c  Participant lowers self to all fours. Figure 7.6d  Participant moves to side-lying position and
uses hand to control legs.

Figure 7.6e  Participant swings legs over edge of pool. Figure 7.6f  Participant enters water from diving or
prone position.

144
 Prerequisites to Safe, Successful, and Rewarding Programs 145

Transfer From Wheelchair to Pool Deck Using a Forward Pivot

1. Repeat steps 1 through 3 in the previously described transfer (the transfer from wheel-
chair to pool deck).
2. Instruct participant to place arm on one side of the armrest or on wheelchair seat
rail.
3. Instruct participant to place the other hand down on the mat far enough out so the
hips won’t contact wheelchair parts (see figure 7.7a).
4. Instruct participant to pivot (lower) hips to pool deck gently, contacting buttocks squarely
on the mat (figure 7.7, b-c).
5. Repeat steps 7 through 9 from the previously described transfer (the transfer from
wheelchair to pool deck).

Figure 7.7a  Transfer using forward pivot. Lifter stabilizes

wheelchair and participant positions body.

Figure 7.7b  Participant pivots hips. Figure 7.7c  Participant slowly lowers buttocks squarely
onto mat.
146 Adapted Aquatics Programming

Transfer From Pool Deck to Wheelchair

1. Instruct aide to position the wheelchair next to transfer spot, not pool edge, and place
a mat there for comfort and safety.
2. Instruct aide to remove the seat cushion (thus reducing height), position wheelchair
with casters back, lock brakes, remove footrests, and hold wheelchair.
3. Instruct participant to sit sideways, facing the wheelchair, and move up onto knees by
pushing up with the hip-leaning-side hand (see figure 7.8a).
4. Instruct participant to pull and stabilize with other hand on seat by opposite armrest
(see figure 7.8b).
5. Instruct participant while in kneeling position to rest chest on the seat, while you sta-
bilize hips in kneeling position and, if required, lift at waistband.
6. Instruct participant to place one hand on the lower part of the armrest and one on the
upper part of the other armrest.
7. Instruct participant to push down, extending arms, until hips are above wheelchair seat.
8. Instruct participant to not let go or change hand positions.
9. Instruct participant to rotate or pivot hips toward the downhill arm (see figure 7.8c).
10. Instruct participant to lower and position self in wheelchair.

Figure 7.8a  Transfer from pool deck to wheelchair. Par- Figure 7.8b  Participant faces chair in kneeling posi-
ticipant faces wheelchair in side-sitting position. tion and stabilizes wheelchair.

Figure 7.8c  Participant presses up body, pivots

hips, and positions self in wheelchair.
 Prerequisites to Safe, Successful, and Rewarding Programs 147

Transfer From Pool Deck to Wheelchair With Backward Movement

1. Repeat steps 1 and 2 from previously described transfer (the transfer from pool deck
to wheelchair).
2. Instruct participant to position back of trunk in front of wheelchair with hips slightly
to the side and legs stretched out in front.
3. Instruct participant to cross legs so that the chair-side leg is on the outside or top.
4. Instruct participant to place chair-side arm on the seat next to the armrest and the other
hand as close as possible to the hip, or to place both hands on the seat if shoulder
flexibility allows (see figure 7.9a).
5. Instruct participant to lift hips up into wheelchair and to avoid hitting the sacrum or the
hips on the wheelchair front assembly or catching under the seat (see figure 7.9b).
6. Tell participant that when the hips are in the chair, to extend the upper body (without
excessive pushing on the legs to get up, as dislocation of hip or knee may occur).

Figure 7.9a  Transfer with backward movement. Partici- Figure 7.9b  Participant extends arms, lifting buttocks
pant positions body in front of chair. into wheelchair.

Care in Locker Room

Participant Care and Safety
Although the participant is most likely concerned
about fun, swimming, and fitness, these aspects
should never supersede safety. You must be aware of
participant care in special-needs, family, and locker-
room changing areas. You must practice fundamental
safety procedures from the time that participants enter
the changing areas to the time that you return them
to the care of their families or caregivers.
and Shower Area
The locker room may be the place where staff appre-
hension runs high as you all confront the task of get-
ting numerous participants with various mental and
physical disabilities undressed, toileted, and into their
swimsuits; getting their clothes organized and stored
in lockers; and safely moving them to the pool. Two
ways to reduce the stress are to prepare for the arrival
of the participants and to schedule enough time for
them to get ready for class. Before participants arrive,
148 Adapted Aquatics Programming

be sure that the locker room has enough changing
space for each person and that it is equipped with
changing tables, benches, or mats for those who
change in the supine position. In addition, be sure
to have adequate supplies of gloves, diapers, wipes,
sanitary pads, first aid kits, and cleaning agents.
When participants arrive, make the time spent in
the locker room a positive, productive experience that
enhances trust and rapport. Use appropriate verbal
and body language to project a professional but
low-key attitude to minimize the risk of embarrassing
participants or otherwise damaging their self-esteem.
Introduce participants to locker-room facilities and
briefly explain to them how to use the equipment they
need. Ensure that everyone has adequate locker space
at appropriate physical heights. Label the lockers of
those participants who may be unable to recognize
their own clothes.
Because the locker room is often the participant’s
first and last contact with the facility and its staff,
its ambiance, accommodations, and condition
make an important contribution toward the overall
aquatic experience; in fact, the locker room can be
a determining factor in an individual’s return. Many
organizations have implemented the requirements of
the ADA, ensuring that locker rooms are accessible
(see chapter 6 for more specific details).
The locker room also presents an opportunity to
build confidence and self-esteem by providing a
naturally reinforcing environment in which to practice
activities of daily living (ADLs), such as dressing and
following personal hygiene.
Thus, you should allow partici-
pants as much time as possible
to get ready on their own. To
increase efficiency and suc-
cess, request that participants
arrive in clothing with uncom-
plicated closures, such as shoes
with Velcro instead of laces.
Encourage independence in
those who have greater abili-
ties so that you can turn your
attention to those who require
more assistance.
changing rooms has increased (see figure 7.10). This
diverse population includes individuals with disabili-
ties, aging citizens, and parents with young children.
People in each of these groups have special hygiene,
dressing, and morality concerns that are no longer
met by single-sex locker rooms. Appropriate equip-
ment greatly aids in changing clothes, showering, and
attending to hygiene. The posting of and adherence
to rules such as the following from the Macedonia
Department of Recreation and Parks facilitate reason-
able accommodations for opposite-gender caregivers’
usage of locker rooms in recreation facilities:
• The family changing room is available for
people with children under 7 and for people
with special needs.
• The main doors to this area will no longer be
locked. This way all users will have free access
to their belongings when needed.
• This area now has two private areas for chang-
ing: the bathroom and the curtained area.
• The bathroom should be locked when in use.
• Please limit your time in the private areas to 5
minutes, as others may be waiting.
• Do not store any personal belongings in the
private areas.
• The common area contains lockers for storing
belongings and a diaper changing station for
infants and toddlers (Macedonia Department
of Recreation and Parks, 2005).

Family Changing Rooms

Due to the increased diversity
of participants using local rec-
reation facilities (i.e., facilities
at YMCAs, community cen-
ters, or universities) and the
federal legislation mandates, Figure 7.10  Family changing rooms might be considered a reasonable accommo-
the demand for alternative dation.
 Prerequisites to Safe, Successful, and Rewarding Programs 149

Dressing Bathing and Grooming

All staff should be ready to assist participants in Encourage showering after pool activity. This is
dressing, undressing, washing, and other matters another opportunity to have participants practice
of personal hygiene. Sometimes assisting individu- an ADL and to thereby foster independence (figure
als with severe disabilities can be a real challenge. 7.11). Staff members may need to model correct
Consulting with caregivers, parents, and therapists to showering behavior, as some students are frightened
learn their tricks of the trade may help when working of or unfamiliar with a shower. During a shower is
with individuals with multiple disabilities. also a good time to check each participant’s skin
When working with individuals who require assis- for signs of irritation or poor circulation. Report all
tance or must be completely dressed by you, position suspected lesions to the appropriate personnel. To
them as comfortably as possible. Whenever the situa- make a shower facility easier and safer to use and to
tion allows, place such individuals in a sitting position encourage independence, provide a sponge or bath
so that they can see what is happening, as being able mitt with a soap pocket so that the participant can
to see will help them feel less frightened and more reach with one hand. Provide a terrycloth bathrobe
secure. If the individual’s age, disability, or weight will or poncho to keep the participant warm and begin
not permit sitting, try a side-lying or supine position. A the drying process (Hale, 1979). See also recom-
firm pillow placed under the head will help raise the mendations in chapter 6 under “Locker or Dressing
head and shoulders to inhibit abnormal postures and Rooms” on page 110.
facilitate movement. Do not, however, place individu-
als with spasticity and abnormal reflexes in the supine
position, as in this position they tend to extend the neck
and shoulders back, stiffen the hips and legs, and cross
the legs. Finnie (1997) and French, Gonzalez, and
Tronson-Simpson (1991) suggest the following tips for
dressing participants with spasticity or hemiplegia (due
to stroke, brain injury, or cerebral palsy):
• Place clothing within easy reach.
• When pulling clothing over an individual’s
head, position the head with the neck flexed
and the chin tucked rather than letting the neck
go into extension.
• Try to keep the individual’s head aligned with
the midline of the body.
• Dress the least functional extremity first.
• Remove clothing from the most functional
extremity first when undressing.
• Do not try to pull the participant’s arm though
the sleeve by pulling on his fingers, as this will
immediately make the elbow bend.
• Insert the arm into the sleeve as far as you
can, then reach into the sleeve and help the
individual straighten the arm while you pull
up the sleeve.
• Have participant sit symmetrically, either sitting
sideways cross-legged with both legs to one side
or sitting with both legs stretched out front.
• Bend the participant forward at the hips to make
it easier to bring the arms forward.
• If a participant’s toes curl as she tries to put on
shoes and socks, bend the hip and knee, cross- Figure 7.11  Accessible showers facilitate indepen-
ing one leg over the other. dence.
150 Adapted Aquatics Programming
Urinary and Bowel Management
The care of individuals who experience bowel or
bladder incontinence is a concern to participants
and instructors alike. Those participants who have
impaired urinary or bowel function may feel anxious
and avoid social interaction because they fear the
embarrassment of revealing the related appliances or
publicly experiencing involuntary urination or def-
ecation. You must respectfully assess each individual’s
needs and respond accordingly.
As with other conditions, the methods for urinary
and bowel management depend on the severity of
the impairment. For some people, management is
an issue of bladder and bowel training, which neces-
sitates reminding them to use the facilities before
and after class. Resources by Snell and Brown (2000)
and Westling and Fox (2004) provide excellent sug-
gestions for toilet training individuals with severe
disabilities. You need to be part of the team that rein-
forces responsible behavior in this self-care area. For
individuals who have partial or total loss of bladder
and bowel function due to more severe mental or
physical disabilities, diapers, protective pants, internal
or external catheters, and external waste collection
pouches may be necessary.
Speak privately to individuals and caregivers to
become knowledgeable in the care of various cath-
eters and external waste collection systems used by
your participants. Be sure to ask about what to do if
the stoma appears inflamed, starts to bleed, or breaks
down, and report any abnormalities. Waste collection
pouches should be emptied and reattached before
entering the pool and after activity as part of the
grooming process. Before leaving the locker room, be
sure that the pouch is correctly attached to the stoma
and is watertight. Wear protective gloves whenever
you give care that involves exposure to body waste
or fluids. In addition, remember that natural rubber
latex (NRL) is a health concern for individuals (e.g.,
people with spina bifida) who have latex allergies.
Use nonlatex gloves when assisting individuals who
are predisposed to such allergies. Whatever the
system for bowel management that is employed, be
sure to give the participant the privacy and time to
attend to her personal needs.
Regardless of the precautions taken, accidents
are bound to happen. When they do, remember to
respond in a calm, professional manner in order to
preserve the dignity of the individual. Help the par-
ticipant out of the pool and take him immediately to
the locker room to get cleaned up. Follow pool rules
to ensure that the pool is properly sanitized for the
protection of all participants (see chapter 6).
Safety and Injury Prevention
The aquatic environment introduces a host of poten-
tial hazards that may cause injuries. Adapted aquatics
programs have other inherent safety concerns result-
ing from specific instructor–student interactions, spe-
cial equipment, skill development, and instructional
methodology. In addition, many professionals who
conduct recreational, therapeutic, or educational
programs are not trained for ensuring the safety of
participants and personnel in aquatics programs.
Thus, your program must develop and teach preven-
tive and standardized safety practices for supervision,
emergency plans, rules, and other safety principles.
Supervision
The level of swimmer supervision should be specific
to the design of the pool, the number of swimmers, the
characteristics and abilities of the swimmers, and the
activities being conducted. State and municipal regu-
lations may set minimal standards for lifeguarding and
facility occupation, but aquatics personnel should not
limit their safety practices to these regulations. Swim-
mer supervision should include lifeguards as well as
instructors, aides, other facility staff, volunteers, and
even significant others. Organize these individuals
appropriately to maximize safety. An extra set of eyes
during peak activity and an extra set of hands to assist
a swimmer across a slippery deck can help prevent
injuries. Instructor-to-student ratios should reflect the
ability to provide a satisfying educational or recre-
ational activity in a safe environment. All program
staff should receive a proper orientation to ensure that
they understand roles and responsibilities.
Emergency Plans
Preparation is a key to ensuring safety. Thus, your
program should develop emergency action plans for
the variety of accidents, injuries, behavioral problems,
or other events that may occur. Your program direc-
tor should document these action plans and discuss
them with all staff during orientations and in-service
sessions. Lifeguards and ancillary personnel should
practice the emergency rescue procedures, including
using any equipment needed in a rescue. Swimmers
should also practice the appropriate responses to
emergencies by participating in safety drills. Such
drills might include evacuating or simply moving
to other parts of the pool. Don’t underestimate the
value of preparedness and emergency action plans.
Consider, for example, a fire situation in which
nine participants must be removed from a pool via
a mechanical lift and transported by wheelchairs
outside the building.

The arrangement and availability of equipment are
critical to emergency preparedness. Identify rescue
and first aid equipment specific to the conditions,
emergency situations, and swimming population of
your pool. A ring buoy is of no use if the swimmers
don’t have the ability to grasp it, but a rescue tube
could be used for swimmers to drape their arms or
body across. Foam mats are very appropriate if several
of the swimmers are prone to seizures. Of course,
equipment should be easily accessible to all trained
personnel. Proper orientations and drills ensure that
everyone is prepared.
Rules
Many aquatics facilities have general rules to ensure
safety and prevent injuries. However, general rules
may not account for the needs of specific groups
or activities around which the aquatics program is
designed. For example, in order to maintain a stable
and safe body position for instructional or recreational
swimming, an individual may need a flotation device
that has been prohibited by general rules. You must
establish rules based on the needs of the individuals
using the pool and the purpose and type of the pro-
gram activity. Then you must effectively communicate
and enforce these rules.
Posting rules in a visible or common area such as
the pool entrance is the usual way to communicate
them. However, simply posting the rules does not
ensure that program participants are truly aware of
them or have understood and learned them. You may
need to post written rules in alternate forms, such
as in pictures, in braille, or in an audio recording.
Reinforce rules through periodic orientations and
reviews. Routinely discuss with the swimmers the
purposes of the rules as well as the specific behaviors
that violate them.
The key to enforcing rules is consistency. Thus, all
program personnel should enforce a rule in the same
manner as soon as it is broken. Consider explanation,
discussion, modeling, and simple role-playing instead
of the usual time-out or other punishment. Keep in
mind that the purpose of the rules and of correcting
individuals when required is to ensure safety, not to
assert authority.
Other Safety Principles
You can further improve the safety of any instruc-
tional or recreational activity if you adhere to a few
principles. First, always be in positions that permit
you and your participants to see and hear each
other. Effective class organization and appropriate
demonstration and practice formations can also
Prerequisites to Safe, Successful, and Rewarding Programs 151
prevent injuries. Before allowing two classes to take
place at the same time or in rapid succession, predict
any confusion or hazards that might result from the
interaction of the various groups and their different
types of equipment. Facility design, for example, may
limit the number of wheelchairs having access around
the pool and locker room and the number of people
who can fit in the shallow end of the pool during a
beginner swimming class.
A consistent regimen always helps maintain safety
because it reduces the discomfort and fear that partici-
pants might feel when asked to perform unexpected
activities. Provide an overview of the day’s activities
at the beginning of class and preview the next lesson
at the end of class. Be sure that participants under-
stand directions. Follow a standard lesson plan so that
participants become accustomed to the sequence of
class activities.
Recognize additional safety measures that you may
need to implement to protect people with special
physical, cognitive, or behavioral needs. Table 7.1
highlights some difficulties experienced by persons
with disabilities and lists some safety measures that you
can take to effectively respond to these situations.
Mobility
Once participants are dressed for swimming and have
used the restroom, movement to the pool area should
follow a preplanned and systemic procedure. Adher-
ing to a few rules can prevent many accidents and
increase instructional time (Mori & Masters, 1980).
Follow these tips to move groups or individuals safely
from the locker room to the pool and vice versa:
• Assemble students in pairs, lines, or small
groups when moving to the pool area.
• Have aides and volunteers walk beside par-
ticipants, staying between the pool and the
participants.
• Avoid wet spots and remove all obstacles.
• Do not stop along the way to the pool.
• Once in the pool area, seat all students on
assigned mats or bleachers.
• Do not allow engaged motorized wheelchairs
within 3 feet (0.9 meters) of the pool edge.
• Disengage motors upon arrival at the wheel-
chair storage area or lift.
• After class, never leave the pool area until you
have accounted for everyone.
• Always post an aide or volunteer on the pool
deck while participants are changing in case
someone comes back into the area.
152 Adapted Aquatics Programming
Table 7.1
Safety Measures for Potential Difficulties
Difficulties experienced by persons with Safety measures
disabilities
Poor balance and use of canes or crutches, both of which
may cause slips and falls
Inability to distinguish water depth, which can cause injuries
and endanger the participant
Skin lesions from pressure sores prohibiting swimming until
healed
Visual perception problems that can cause participants to
fall
Aggressive behaviors
Impulsive behaviors, such as running on the deck, diving at
the shallow end, or acting irrationally
Sensory and proprioceptive difficulties
Inability to follow directions
You can use aides and volunteers during locker-
room activities, travel to the pool area, and aquatics
instruction. Beware, however, that in their willingness
to help, they frequently carry the slower participants,
often more than necessary. Instruct aides and volun-
teers to encourage ambulatory students to walk or
crawl as much as possible. Have them closely monitor
students who have a tendency to run.
When necessary, provide appropriate support staff for
escorting participants. Identify wet or slippery areas. Use
a broom or squeegee to get rid of puddles. Install rubber
matting with drainage capabilities. Encourage participants
to wear aqua shoes or aqua socks. Install grab bars and
handrails to and from the pool area.
Indicate deep and shallow ends with signs that include
pictures as well as words and numbers. Communicate rules
about swimming in areas appropriate to skill level. Verbally
remind participants who cannot read.
Encourage self-examination and instructor assistance
to identify sores early. Communicate health rules to
participants. Prohibit individuals with open sores from
participating.
Paint steps in contrasting colors or paint a contrasting
color stripe at the edge of each step to denote the end of
the step. Use textured strips, such as raised rubber or sand
embedded, on each step to improve footing. Provide a
spotter at the steps.
Remind participants of overall pool rules. Provide copies of
rules for reinforcement in the home, school, or residential
facility. Enforce rules and follow through on discipline
procedures promptly and consistently. Ask caregivers and
teachers for suggestions as to what behavior management
techniques work with the participant.
Follow measures used for aggressive behavior. Use the
appropriate number and quality of trained staff. Collaborate
with significant others and professional caregivers to learn
the proper methods of reinforcing correct behavior and
decreasing inappropriate behavior.
Identify problem areas. Add additional staff as needed
during activities that may compromise safety. Consult with
an occupational therapist about sensory difficulties, asking
for suggestions for intervention.
Present directions in small increments. Remind participants
about rules at regular intervals. Use preventive measures
and try to project what might happen if the directions are
not followed.
Seizure Management
Since seizures may occur more frequently among
individuals with certain disabilities, aquatics per-
sonnel should have the skills and knowledge to
respond appropriately to such an emergency. As we
have discussed, your aquatics facility should have
an emergency action plan to guide the actions of
personnel.

Some people have many seizures a day but do not
require medical treatment. Individual seizure patterns
determine if an occurring seizure is normal or abnor-
mal for a given person. For safety reasons, request a
participant who is subject to seizures to list specific
information about his medical condition on a medical
form (see the section on seizures in chapter 9 for a
description of possible seizure behaviors).
A medical emergency exists if a seizure lasts more
than a few minutes or if seizures continue in rapid
succession (status epilepticus). Some short seizures
may also require medical treatment, such as a seizure
that occurs when the person has never had a seizure
before, or seizures that recur during the session and
are unusual for the individual. Regardless of the type
of seizure, always ensure that the person has an open
airway and is protected from physical injury caused
by contact with other people or objects or by physical
restraint. When in doubt, always activate EMS, the
emergency medical system.
The following suggestions will help you manage
a seizure during and after an incident:
• Time the seizure. Notice what is physically
happening to the person. Give this information
to caregivers, emergency technicians, and, if
appropriate at a later time, the participant.
• Have foam or gym mats available. These cush-
ion hard decks when the person is removed
from the pool. Drape mats, towels, or blankets
along the pool edge when lifting the individual
out of the pool.
Table 7.2
First Aid for Seizures in the Water
Epilepsy Foundation recommendations
• Support the person in the water with his head tilted so
that his face and head stay above the surface.
• Remove him from the water as quickly as possible with
the head in this position. Once on dry land, examine
him and begin artificial respiration at once if he is not
breathing.
• Take anyone who has a seizure to an emergency room
for a careful medical checkup, even if he appears to be
fully recovered afterward.
• Know that heart or lung damage from ingestion of water
is a possible hazard.
From the Epilepsy Foundation, 2005 and the American Red Cross, 2001.
Prerequisites to Safe, Successful, and Rewarding Programs 153
• After checking for breathing and heartbeat and,
if necessary, starting rescue breathing or CPR,
maintain an open airway and make sure help
is called. Next, survey the person’s body for
additional injuries, such as bleeding, cuts, and
broken bones.
• If necessary, maintain body temperature with
blankets or towels.
• Position the person on her side so that blood,
saliva, or vomit can drain from the mouth.
• After stabilizing the person, let her rest.
• Fill out an incident report, and let caregivers
know what happened.
You can receive additional information and training
on handling seizures through ARC first aid, CPR,
water safety, and lifeguarding courses.
Seizures in the Pool
Although a seizure may be frightening to witness, all
personnel should be prepared to provide immediate
assistance, especially for participants having seizures
in the water. The natural qualities of the water provide
buoyancy and support during a seizure if the indi-
vidual is kept away from the pool edge, equipment,
and others. Table 7.2 provides recommendations for
addressing seizures in the water.
In general, the first aid objectives for assisting an
individual having a seizure in the pool are to keep
the individual’s face above the water, to maintain
an open airway, and to prevent injury by providing
ARC recommendations
• Call or have someone else call 911 or the local
emergency number.
• Support the individual with her head above water until
the seizure ends.
• Get the individual out of the water as soon as possible
(since she may have inhaled or swallowed water).
• Place the individual faceup on the deck and do a primary
survey.
• Give rescue breathing or CPR if needed.
• If the individual vomits, turn her on her side to drain
fluids from the mouth.
• Sweep out the mouth (or suction out the mouth if you are
trained to do so).
154 Adapted Aquatics Programming

support with a minimal amount of restraint. To meet

these objectives, stand behind the individual’s head,
low in the water, and place the individual in a supine
position. Then support the individual under the arm-
pits, shoulders, and head (see figure 7.12). This posi-
tion also helps protect the rescuer from being hit if the
individual’s arms or head flail during a seizure. Pro-
vide only the support needed to keep the individual’s
face out of the water, as unnecessary restraint may
cause injury to both individual and rescuer. Do not
attempt to remove the individual from the pool until
the seizure has subsided. However, do not allow the
individual to remain in the pool if the seizure lasts
for more than several minutes or continues in rapid
succession, if injury or hypothermia occurs, or if the a
person needs CPR.
To remove a participant from the pool, several
rescuers or aides can lift the individual from the water.
You can direct a simple lift by having the rescuers
stand on one side of the individual, roll the individual
toward their chests, and lay the individual on a mat or
towels on the side of the pool (see figure 7.13, a-c).
Render first aid for any injuries and contact EMS if
necessary. The individual’s medical or participation
form should indicate the exact protocols for care in
the event of a seizure. Be familiar with this paperwork
before an incident occurs.

Photos courtesy of Monica Lepore

Photo courtesy of Monica Lepore

Figure 7.13  A lift for seizure management. (a) Rescuers stand

facing the participant’s side and put their arms under his back
and legs. (b) Rescuers roll the participant toward them and step
Figure 7.12  Holding the participant during a seizure in toward the wall. (c) Rescuers place participant on mat in pool or
the pool. on deck.

Seizures in the Locker Room or on the
Pool Deck
The hard surfaces of the locker-room floor and the
pool deck do not offer the same cushioning effect
that the water offers. Therefore, additional first aid
care may be necessary to guard against the physical
injury that a person may sustain during convulsions.
Do not attempt to hold the individual still during
convulsions; instead, use gym mats (if available),
towels, or blankets to cushion the individual and thus
reduce physical injury. You should always ensure that
adequate padding is available in the facility whether
participants are known to have seizures or not—emer-
gencies happen and you must be prepared.
After the Seizure
An individual may experience a variety of physical
and emotional effects once the seizure has subsided.
Some individuals seem drowsy or complain of head-
aches. Others appear confused or feel uncomfort-
able, embarrassed, or frightened. At this time it is
important to offer the individual psychological first
aid. Indeed, emotional support and reassurance are
essential components of seizure management, as they
reduce anxiety and let the individual know that he
is receiving appropriate care. If warranted, take the
individual out of the pool and to a quiet, comfortable
room where recovery can progress. Calmly commu-
nicate the individual’s health status to other program
participants and personnel to allay their concerns. The
incident may also provide a teachable moment—an
opportunity to discuss seizures and how to be of help
when one occurs. However, be sure to maintain the
individual’s privacy.
Hydrodynamics
In order to develop effective and relevant activities
and provide appropriate feedback to individuals in
adapted aquatics programs, you must understand how
Photos courtesy of Monica Lepore
the human body is affected by the aquatic environ-
ment and the consequences of movement in water.
As you already know intuitively, water has sev-
eral properties that make it a versatile and practical
medium in which individuals with disabilities may
move more effectively. Water subjects the body to
two different forces at once: buoyant force, known
as upthrust, and gravity, known as downthrust (Reid,
1979). When a person moves in the water, the aquatic
medium produces a three-dimensional resistance as
no other medium can. You can increase resistance for
strengthening and conditioning purposes simply by
increasing movement speed and therefore increasing
Prerequisites to Safe, Successful, and Rewarding Programs 155
turbulence or you can reduce resistance for individu-
als with poor strength simply by having them slow
their movements (Genuario & Vegso, 1989; Moran,
1979).
Keep specific gravity, buoyancy, hydrostatic
pressure, and temperature in mind when designing
adapted aquatics programs for individuals who may
have an atypical body posture, percentage body fat,
or distribution of body fat. Thoroughly understanding
how water can assist, support, and resist participants’
movements will help you more successfully adapt
body positions for swim strokes and other aquatic
activities.
Specific Gravity
Specific gravity relates to the ability of an object to
float or sink. The specific gravity (relative density) of
water is 1. The term specific gravity is used to describe
the density of a liquid. An object with a specific grav-
ity less than 1 floats, while an object with a specific
gravity greater than 1 sinks. When determining the
specific gravity of the human body, three factors come
into play: the ratio of bone weight to muscle weight,
the amount and distribution of fat, and the depth and
expansion of the lungs. In general, this means that
a person who possesses more muscle (and density
of bones) is more likely to sink. When muscle mass
has not developed or has decreased due to atrophy,
a higher portion of the body mass may be fat and the
person may be more likely to float. The body’s center
of mass, the point around which its mass is evenly
distributed, is usually in the pelvic region. Due to
paralysis, atrophy, dystrophy, or irregular bone density,
the weight of each body part, the percentage body
fat, and the distribution of fat may cause the center of
mass to differ from the norm. The center of buoyancy,
the point around which the body’s buoyancy is evenly
distributed, may be affected not only by structural
differences of individuals with disabilities but also by
lung irregularities in individuals with asthma, cystic
fibrosis, chronic pulmonary obstructive disorders, and
other chronic respiratory dysfunctions.
Buoyancy
During the initial water session, you should carefully
determine the floating ability of each individual in
various positions (see figure 7.14). The jellyfish float
is an easy test of buoyancy in the prone position.
While in chest-deep water, have the individual take
a breath, bend forward at the waist, put her head in
the water, and flex her knees slightly. Her arms should
hang toward the bottom of the pool, her feet should
be slightly off the pool bottom, and her back should
156 Adapted Aquatics Programming
Figure 7.14  Various floating positions of people with varying body density. The
person on the top left side has a lean body mass of more than 1, and therefore is a
nonfloater. Participants in the center and on the top right side have a body mass
of less than 1, and therefore they float.
be slightly rounded. If the person sinks, her specific
gravity is likely greater than 1. If a portion of her back
remains above the surface, there is a good chance that
she will float on her back with at least her face out of
the water. At this time, you can also check the person’s
ability to maintain a stable body position without tip-
ping to one side or another. During floating, the center
of mass is below the center of buoyancy. Extreme
variations in body posture, center of mass, or center
of buoyancy may cause an individual to rock to one
side, float in a vertical position, or fail to maintain a
floating position at all. If a person cannot maintain
a balanced position and shifts to one side, you may
need to help her adapt her strokes so that she can
maintain body position during propulsion.
As previously mentioned, water has a specific grav-
ity of 1. On average the human body has a density of
0.974. Lean body mass is typically 1.1, but fat mass
has a density of 0.9, so you can see how someone
with a density over 1 sinks and someone with a den-
sity under 1 typically floats (Cole & Becker, 2004). In
contrast to people with a specific gravity greater than
1, some individuals, such as those with spina bifida,
possess excessive floating potential in the lower
extremities. A person with paralysis or paresis affect-
ing the legs and hip area may have no trouble floating
but may not be able to return
to a vertical position easily due
to excessive buoyancy in the
hip and buttock area. Thus, as
a safety precaution, remember
when initially evaluating an
individual to observe his ability
to recover from floats.
Buoyancy is the force that
exerts upward thrust and coun-
teracts the force of gravity. The
buoyant force assists move-
ment toward the water surface
and resists movement away
from the surface (Selepak,
1994). Buoyancy is explained
by Archimedes’ principle,
which states that a body in
water is buoyed up by a force
equal to the weight of the
water displaced (ARC, 2004a,
p. 30). When a person enters
the water, his body displaces
a certain amount of that water.
When the weight of the water
displaced is greater than his
weight, he will be able to float
in the correct position.
When a person moves on land, she is greatly
affected by gravity and she balances around the
center of gravity. But in water, a swimmer must learn
to balance around the center of buoyancy, which
is located in the chest area and usually higher than
the center of gravity. The change in balance may not
seriously affect a swimmer without disabilities, but
the swimmer with a disability may have adapted her
personal body balance to fit her needs on land. Thus,
this swimmer will need time to find her personal bal-
ance in the water. Moreover, flotation devices will
require additional adjustments because if the sup-
port is not in the appropriate place, balancing may
be more difficult (see also the discussion of flotation
devices in chapter 6).
The support and assistance that buoyancy provides
allow an immersed body to overcome most of the
effects of gravity (Moran, 1979), making it feel lighter
in the water. Up to 90% of body weight on land is lost
in the water, and therefore movements that may be
painful, difficult, or impossible on land become pos-
sible in the water. As a result of the near weightless-
ness in water, the participant can move more freely
while controlling stress on weight-bearing joints.
By changing the depth of the water the participant
is moving through, you can adjust the amount of work

the individual does. When people are submerged up
to the neck (up to cervical vertebra C7), they bear
approximately 8% of their body weight, whereas
when people are submerged to the xiphisternal
line (about chest high), a male bears 28% of his
body weight and a female bears 35% of her weight
(Selepak, 1994). These percentages increase as more
of the body is held out of the water. Differences in the
distribution of body mass result in different centers
of gravity and buoyancy and thus affect the male
and female weight-bearing percentages. Males tend
to have a higher percentage of weight in the upper
body as opposed to females, who carry most of their
weight in the lower body.
When an individual is submerged in water, he
can focus his energy on making functional move-
ments rather than on carrying the body weight. Thus
water allows individuals who usually can’t maintain
an upright position on land to walk or stand on their
own. Individuals who have difficulty moving body
parts against gravity on land may be able to use the
effects of buoyancy to move more freely and effec-
tively in the water.
Resistance
In addition to providing support and assistance, water
can provide resistance. Any object that attempts to
move through the water meets with resistance. Having
some knowledge of form drag and wave drag can help
you grade exercise difficulty or improve stroke poten-
tial. Form drag is the resistance related to a swimmer’s
shape and body position when moving through the
water (ARC, 2004a, p. 34). When a person glides
through the water, she can glide more efficiently by
presenting a streamlined position that decreases form
drag. As the surface area that the water must pass
around increases, as in the case of someone with a
body part out of alignment, the form drag increases,
and the person cannot glide as far. In addition, the less
streamlined the person is, the more turbulence her
movements create behind her. This water turbulence
can impede forward momentum by creating eddies,
or small whirlpool turbulence, which in turn create
a drag force called wave drag.
Using Buoyancy and Resistance
By combining fast or slow movements, streamlined or
nonstreamlined movements, and varied water depths,
you can control the water assistance and resistance.
For individuals who are weak, slow streamlined work
is the most manageable. As a person gets stronger,
increase resistance for improved muscular strength
Prerequisites to Safe, Successful, and Rewarding Programs 157
and endurance by introducing natural turbulence
through faster movements, equipment (e.g., fins or
hand paddles) that increases the body’s surface area,
and artificial turbulence created by you or other
people in the pool churning up the water. (See also
“Coaching Swimmers With Disabilities” on page 272
in chapter 12.)
Water Temperature
Another property that affects an individual’s ability
to perform aquatic activity is water temperature.
Variations in water temperature can cause different
physiological effects, including changes in heart
rate. Cooler water (80 °F or less, or 26.7 °C or less)
is recommended for strenuous exercise in the pool.
But most individuals in adapted aquatics programs do
not participate in the strenuous activity that requires
a cooler water environment; quite the contrary, most
of the participants need warmer water to perform to
the best of their abilities. In general, water that is 85
°F (29.4 °C) or warmer aids in relaxation and thus
facilitates greater freedom of movement. Moreover,
an individual will find it easier to concentrate on the
task at hand if she is comfortable and relaxed. Cer-
tainly, it won’t matter that buoyancy makes the body
feel lighter if a person with spasticity cannot reap
the benefits because the water is too cold or the air
temperature is cooler than the water! While you will
find very few exceptions to this warmth rule of thumb,
keep in mind that evidence has clearly shown that
individuals with multiple sclerosis have a negative
reaction to warm water due to nerve transmission
dysfunction and fatigue following exercise in warm
environments (NMSS, 1993).
Positioning and Supporting
Participants
Once an individual is in the water, you will often
need to help him to maximize relaxation, learning,
and mobility. Touch, hold, assist (move), and position
the participant and his body parts in order to provide
a comfortable, safe, and effective learning and per-
forming environment. A respectful and appropriate
approach will meet your participant’s most basic
needs for safety and for feeling safe.
Touching Participants
In order for participants with disabilities to feel safe
in an aquatic environment, you may need to touch
158 Adapted Aquatics Programming
them many times during instruction, practice, and
dressing. Use the fundamental skills discussed in this
section with individuals who need support for safety,
learning, practice, and mobility.
The art of touching has many implications in the
aquatic environment. Touch has been used as part
of the healing process, as a way to channel energy,
as the medium for massage, and as a necessity for
healthy emotional growth. The term therapy hands
denotes the effective use of touching, supporting,
positioning, and handling of people to facilitate
greater movement potential (Cratty, 1989). Good
therapy hands are important, whether or not water
is used, for therapeutic, recreational, or educational
means. Knowing where to place your hands and
body so that a participant has the best chance to
practice skills is as important as a verbal explana-
tion or visual demonstration. Some individuals will
need full support and hands-on, or tactile, teaching
in order to accomplish aquatic skills. Individuals
who are deaf and blind, who are quadriplegic, or
who have cerebral palsy will most likely need you to
manually guide them through skills as well as hold
them in the proper positions for executing the skills.
This guidance will help these and other participants
feel the movement kinesthetically. Tactile teaching
is also good for individuals who have problems with
their body image or difficulty with proprioceptive
input, conditions that result in not knowing where
the body is in space. Tactile teaching may positively
affect sensory input and give individuals with body
awareness problems a channel for learning.
Trust and Abuse
Good touching, holding, and guidance improve
rapport and enable a participant to try more difficult
skills due to the increased trust felt between you and
the swimmer who needs physical cues and emotional
and physical support. You should, however, use the
lightest and briefest touch that is still effective. For
example, you might gently prompt a participant to
complete the action. But pulling, tugging, or drag-
ging the participant through various motions does not
represent therapeutic touching and handling.
The relationship between participant and instruc-
tor or aide requires close physical contact. Because
of this requirement, participants and their caregivers
may be concerned about what constitutes necessary
touching and what constitutes abusive or negligent
touching. Child abuse, molestation, and other per-
verse uses of touch have created negative attitudes
toward touch in American society. Children, young
adults, and people who have intellectual disabilities
are cautioned by their parents and caregivers about
the dangers of people touching them. Since, as an
aquatics professional, you are in situations in which
you touch people wearing little clothing, you must
directly address this subject with participants, par-
ents, and caregivers. Talk openly with them about
the kinds of touching and holding that you will need
to use. Demonstrate the specific holds and positions.
Encourage caregivers to don their bathing suits and
feel what each hold entails. In addition, videotapes
of swimmers in past programs are helpful to provide
examples of actual touching techniques.
Beyond the concerns raised by fears of abuse, you
must take into account the participants’ particular
conditions and disabilities and then observe appropri-
ate precautions to protect both the participants and
yourself. These conditions may include brittle bones
(in people with osteogenesis imperfecta), fragile
skin (in people with skin lesions, frailty, or advanced
aging), poor circulation (in people with diabetes or
paralysis), dislocation and subluxation of joints (in
people with cerebral palsy or spina bifida), and tac-
tile defensiveness (in people with hypersensitivity to
touch, such as those with pervasive developmental
disabilities). For specific information about each of
these conditions, see chapter 9.
Ultimately, your interest in adequately briefing par-
ticipants and their caregivers on your tactile approach
as well as interviewing them regarding relevant medi-
cal conditions will demonstrate your respect for each
individual in a positive, proactive manner.
Holding Participants
The various ways to successfully hold participants in
water are also a fundamental concern. When a par-
ticipant is in the supine position (see figure 7.15), you
can stand behind the swimmer and hold her under
the armpits. The swimmer may then rest her head
on your forearms. If more support is necessary, you
can move closer and slide the whole forearm under
the swimmer so that his armpit is in the crux of your
elbow. The swimmer may then rest his head on your
shoulder. You should be in deep enough water to sup-
port the participant; if not, bend down so that your
shoulders are even with the participant’s head. If the
participant needs eye contact while on her back, you
can stand next to her and put one hand under her
hips and the other under her shoulders, neck, or head,
depending on the level of support needed (see figure
7.16). Although this position may be necessary for
individuals with hearing impairments (for lip reading
or signing) or for frightened swimmers (for security in
seeing you), it limits mobility and freedom because
the swimmer cannot move the arm closest to you
while in this position.

Photo courtesy of Shawn Stevens
Figure 7.15  A supine hold from behind.
If the participant is lying on her side, it is best to
support the head, if needed, or support her under
one arm and at the hip from behind. A swimmer,
especially an adult, lying prone is hard to support. If
necessary, face the prone swimmer and support him
under the chest or armpits (see figure 7.17). A good
resource for various holding positions, especially
positions for children, can be found in the Water
Safety Instructor’s Manual (ARC, 2004b).
Figure 7.17  The prone hold provides support and face-
to-face communication.
Prerequisites to Safe, Successful, and Rewarding Programs 159
Figure 7.16  A supine hold to the side allows the partici-
pant to make eye contact while on the back.
Assisting Ambulation
Mobility in the water is not limited to swimming posi-
tions. Walking is a skill most individuals like to use
when talking to others, warming up, or moving from
one part of the pool to another. Since participants
with disabilities vary in their ability to walk, you
should devise numerous ways to assist them. When
walking with a participant who uses a wheelchair for
mobility or has a great deal of difficulty walking in
the water, place yourself (or an aide) in front, facing
the participant. Support the participant’s rib cage or
underarms while the participant’s hands rest on your
shoulders. If additional help is available, have an aide
or another instructor stand behind the participant,
giving support at the hips (see figure 7.18). Encourage
the participant to stand as erect as possible.
Participants who use walkers, crutches, or canes
will need two-person support only if they have severe
posture problems or are very frightened. They may
need only your hands held out in front of them,
an arm to lean on, the use of the pool gutter, or no
support at all. Remember, the deeper the water the
participant stands in, the more buoyancy there is to
support independent walking.
In contrast, often a participant who is an indepen-
dent walker on land has difficulty in the pool due to
impaired sense of depth, poor spatial awareness, or
frequent seizures and will also prefer assistance in the
pool. In these situations, you, an aide, or a significant
other may act as a spotter, providing assistance when
160 Adapted Aquatics Programming
Photo courtesy of Shawn Stevens
Figure 7.18  Assisting ambulation.
necessary. Individuals with cognitive or behavioral
disabilities may also need someone in the water with
them in order to keep them on task and to ensure the
safety of themselves and others.
Working on the pool deck and in the locker room
also requires various holds, supports, and other assis-
tance positions. Brainstorming with the participant
and significant others will help provide viable options
for assisting with walking on deck and in the locker
room. For example, you may find that when walking
on deck with a person who has balance problems, it
is better to have one spotter on each side, each with
one hand near the participant’s waist and one hand
supporting the elbow.
Positioning Participants
Not surprisingly, a participant’s position during
transfers and skill development may affect the par-
ticipant’s ability to perform a skill or be safe in the
water. Individuals who cannot support themselves
during explanations and demonstrations need you
to be sensitive to the way you are holding them. For
example, lying prone with the head held up is not
a comfortable way to view demonstrations or any
other interaction in the pool. Some individuals need
specific positions in order to have more freedom of
movement. In particular, individuals with spasticity
or abnormal posture and reflexes need special atten-
tion in positioning. The most common populations
experiencing spasticity are people with cerebral palsy,
traumatic brain injury, spinal cord injury, multiple
sclerosis, or stroke. Individuals with cerebral palsy,
traumatic brain injury, or profound mental retarda-
tion may also exhibit abnormal reflexes and postures
(Finnie, 1997; Harris, 1978).
Since inhibiting abnormal reflexes and postures
and facilitating proper body movements are in the
realm of physical therapy, as an aquatics instructor,
you should seek the input of the participant’s physical
therapist while setting up a program. You may learn,
for example, that placing the participant in a supine
position and performing lateral swaying decrease
spasticity. In addition, you may learn that adding a
rotational motion at the end of each sway is help-
ful. You need two instructors or one instructor and
a flotation device near the swimmer’s head for this
action (Campion, 1991). The physical therapist may
also recommend symmetrical activities that force the
participant to use both sides of the body simultane-
ously to promote more normalized muscle tone and
more control. Therefore, don’t hesitate to use the
physical therapist as a resource.
As in all swimming, the position of a participant’s
head may dictate what the rest of the body does. Be
aware of this and facilitate a position that promotes a
neutral or slightly tucked chin with the head aligned
with the midline of the rest of the body. This position
has been shown to allow better movement.
 Prerequisites to Safe, Successful, and Rewarding Programs 161

Summary you provide hands-on, respectful support, position-

You must possess the fundamental skills discussed in
this chapter in order to provide safe and comfortable
aquatic environments. Remember, developing trust
and rapport is the first step to establishing a relation-
ship and overcoming communication barriers. Look
carefully at your verbal and nonverbal language to
ensure that you are communicating positive and
caring messages. Beyond communication, work on
developing positive interactions with participants as
ing, dressing, and hygiene care. Quality programs
that include participants with disabilities require
you to know how to apply hydrodynamic principles,
use transfer techniques, provide locker-room care,
and plan for safety to ensure that you meet the
basic needs of participants and their families. With
proper communication, a consistent learning envi-
ronment, and preestablished plans for transferring
and assisting participants, your program will be on
its way to meeting the needs of your participants
with disabilities.

Chapter 7
Review 1. What are potential barriers to initial communication between you and a
participant with a disability?
2. List questions that you must answer before transferring an individual.
3. List general techniques of lifting and transferring.
4. What does the term therapy hands mean?
5. Why is physical contact between instructor and participant an important
issue?
6. What additional safety precautions should you exercise in an aquatic set-
ting for individuals with disabilities?
7. What procedure should you follow if someone has a seizure?
 8
Instructional
Strategies

O   n the first day of school, the new aquatics teacher was excited to finally open
a new high school natatorium and to meet her new students. However, during
her very first class something odd caught her eye. One of the students sitting in
the bleachers had a dog! The teacher introduced herself to the student, who
was named Sally, and stated that she had two problems. One, the dog was not
allowed on the pool deck, and two, it wasn’t safe for a student who was blind to
take the aquatics class. Sally informed her school APE teacher and her parents
of the embarrassing episode. A meeting of all parties was quickly assembled. The
aquatics instructor was informed of the definition of a reasonable accommoda-
tion and that the guide dog would be allowed on deck. The instructor was also
told that Sally’s mother was on the school board and was not pleased that her
daughter was denied access to the natatorium she had supported. Sally was
allowed to continue with the class. The APE teacher agreed to consult with the
aquatics instructor to assist with instructional strategies, including the appropriate
use of a tap stick, stroke counts, and environment changes (Sally swims in the
lane next to the deck, allowing the instructor to reach her with a tap stick and
giving Sally easy access to pool ladders). The aquatics teacher agreed to take
the AAPAR Adapted Aquatics Instructor course. The instructor has learned much
from Sally and other students with disabilities and now coaches several students
who are blind and working toward USABA competition.

163
164 Adapted Aquatics Programming
A successful aquatics program does more than
offer individuals with disabilities an opportunity
to play in the water; it teaches swimming and water
safety skills. When the instructor understands how
to manipulate variables within various placements,
he can provide effective instructor–participant inter-
actions, enabling learning to occur. Understanding
the process of learning and the factors that affect
learning provides the instructor with insight into how
to effectively design and deliver instruction in both
general and adapted aquatics programs. Indeed, the
acute needs of some participants with disabilities
demand that the instructor develop unique strategies
for teaching and examine the processes of learning,
both of which are prerequisites for adapting tradi-
tional instructional design and delivery. This chapter
discusses the requirements for teaching and learn-
ing that are needed to appropriately adapt aquatics
instruction for individuals with disabilities.
Chapter Objectives
From this chapter, you will learn the
following:
* The process of learning involves three
different stages.
* There are physiological factors that
affect learning.
* There are psychological factors that
affect learning.
* There is a process of teaching, facilitat-
ing, and guiding individuals to learn.
* Addressing behavior problems involves
formal and informal behavior modifica-
tion.
* Modifications in swim strokes result in a
functional and fun aquatic experience.
The Learning Process
Your teaching will be effective if you remember and
use the principles of the way people learn (ARC,
2004b). Remember when teaching individuals with
disabilities that there is more than one method of
instruction and that individualizing your approach
will help improve the teaching–learning process.
Participants’ learning experiences occur in many
different settings and ways. All people go through
distinct stages as they acquire motor skills, includ-
ing aquatic skills. However, participants arrive in
the aquatic setting with various levels of motivation,
experience, and abilities. They also arrive with their
learning at different stages (Schmidt & Wrisberg,
2000). According to Fitts and Posner (1967), individu-
als go through three stages when learning new motor
skills. In the first, or cognitive, stage, the participant
thinks about what to do before moving. Movements
are usually awkward, slow, and highly variable. In
addition, the participant relies on the instructor for
feedback, primarily because the participant knows
that he is not performing correctly but does not
know what he needs to do to improve. The swim-
mer enters the second, or associative, stage as he
gains more experience and his movements become
more refined. In this stage the swimmer has a better
understanding of the movements and objectives and
spends less time on gross motor aspects. The swimmer
tries to associate some part of the aquatic movement
with other movements in his repertoire in order to
perform the stroke more automatically and rhythmi-
cally. In the final, or autonomous, stage, the swimmer
thinks very little about specific movements, corrects
himself without the instructor, and is often capable
of performing more than one task (Magill, 2001). In
order to become an efficient swimmer, an individual
must move to the autonomous stage. However, some
individuals with disabilities may never get to this stage
for many reasons, including impaired sensory input,
memory, input organization and interpretation, motor
planning, motor output, or internal feedback.
Physiological Factors Affecting
Learning
Aquatic skills do not simply emerge; you must pres-
ent them and give participants appropriate practice
activities to develop them. The acquisition of aquatic
skills is based on the participant’s readiness to receive
the skills, ability to understand the goals, and oppor-
tunities to practice the skills at a challenging but
manageable level and to receive feedback. Readiness
of participants with disabilities frequently lags, and
these participants have difficulty in learning age-
appropriate skills (Auxter, Pyfer, & Huettig, 2005). As
neurological maturation takes place, the participant
can learn more. Physiological factors are anatomical
and physiological variations in an individual’s body
(see figure 8.1) that affect how and what a person
learns. These factors include how pathology, disease,
disuse, or environment affect the body’s abilities to
function and how medications alter function. You
must ascertain the participant’s approximate level of
neurological maturity or you may, for example, spend
5 days a week for 5 months teaching rhythmic breath-

Residential Program: The Mary Campbell Center, Wilmington, DE.
Figure 8.1  Physiological characteristics such as wrist
contractures (seen here) can limit the acquisition of new
skills.
ing to the side in coordination with the arm stroke for
the front crawl when the individual is not neurologi-
cally mature enough to achieve coordination. Thus
you have wasted time that you should have devoted
to a more developmentally appropriate skill.
Body Systems
Learning a motor skill is a progressive process that
depends on taking environmental information into
the central nervous system. The information then
needs to be processed in order to direct movement
patterns and skills (Auxter et al., 2005). Swimming
and aquatic activities are lifelong activities available
in all communities. Many constraints like arthritis
affect the learning or execution of an aquatic skill.
Other constraints to functional ability may result from
limitations in body structure and function (achondro-
plasia, or short stature), abnormal posture (kyphosis),
poor reflex integration (cerebral palsy), abnormal
muscle structure (muscular dystrophy), amputation,
and obesity. Naturally, if impairment occurs in one
or more body systems, learning to swim can be quite
a challenge.
For example, cardiorespiratory disorders, such
as asthma or cystic fibrosis, may limit the amount
of work that the participant can safely perform in
a single session. Joint and bone disorders, such as
arthritis, juvenile rheumatoid arthritis, osteogenesis
Instructional Strategies 165
imperfecta, short stature, and lupus, may alter body
shape and size. Individuals with joint and bone dis-
abilities, amputations, or posture disorders are at a
disadvantage when it comes to propulsion. As we
have discussed throughout this book, some individu-
als require warmer water, adapted strokes, and unique
aquatic activities. The list of disabilities and their
unique manifestations and needs goes on and on.
Simply put, no matter how well planned your les-
sons, how creative your instructional strategies, and
how powerful your teaching methods, if you do not
assess and plan for an individual’s motor and cogni-
tive capabilities before you start teaching, you’re
wasting everyone’s time and energy. There’s no need
to spend instructional time on the breaststroke kick
if the individual has lower-extremity paralysis or
abnormal muscle tone.
Medication
In addition to congenital and acquired disabilities,
medication can play a positive or negative role
in aquatic learning. As a positive measure, drug
therapy can produce substantial behavioral changes
in individuals with mental illnesses, emotional and
behavioral disabilities, or attention deficit disorders.
In children, stimulants can actually lessen hyperactiv-
ity and improve short-term memory. Unfortunately,
you will find that some people are overmedicated;
this finding is especially likely in people who have
unstable conditions, who are just beginning drug
therapy, or whose body chemistry changes as a result
of puberty. Other drug side effects may cause dif-
ficulty in developing and maintaining physical and
motor fitness. In addition, nausea, vomiting, increased
appetite, weight loss, anemia, visual and hearing
disturbances, hyperactivity, fainting, and inability to
concentrate may all result from medication use. If
an individual takes a medication, use the Physicians’
Desk Reference (Sifton, 2006) to learn about its use,
indications, and possible side effects. Discuss with
a pharmacist possible behavioral and physical signs
caused by the drug and ask caregivers if they have
noted any side effects. Use your knowledge of the
possible side effects to work with the participant and
significant others to develop emergency procedures
and to adapt fitness swims and activities to meet the
needs of the medicated individual.
You must not only be aware of the possible effects
that medication may have on learning and aquatic
performance but also be sensitive to medication
timetables, as missing or delaying a dose may sig-
nificantly alter an individual’s behavior. In addition,
be sensitive to individuals with disabilities who have
an indwelling or intravenous catheter (usually in the
arm) through which medications are injected. Avoid
166 Adapted Aquatics Programming

placing pressure on such areas and ensure that plastic

wrap covers the area during class time.

Psychological Factors Affecting

Learning
Each person is psychologically unique, with a per-
sonal learning rate that depends on a number of
psychological factors. As an aquatics instructor, you
assist the participant through the learning process by
using different styles of teaching (ARC, 2004a, p. 21).
Individuals with disabilities may have psychological
characteristics that hinder the acquisition of aquatic
skills. You should examine psychological factors such
as anxiety, motivation for learning, cognitive readi-
ness, social ability, and preferred learning modality

Photo courtesy of Monica Lepore

before developing instructional strategies.

Anxiety
Anxiety is an uneasiness or a distress felt about an
activity. It stems from elevated fear levels and inhibits
mental adjustment and learning in the aquatic envi-
ronment. Although mental adjustment generally takes
time for new or frightened swimmers, it may take a
greater amount of time when coupled with physical,
emotional, or mental disabilities. Individuals with
poor breath control due to oral muscle dysfunction
or asthma and individuals with limited ability to stand
or hold the wall due to high or low muscle tone are
at a high risk of having fear and anxiety control their
openness to learning (see figure 8.2).
A swimmer experiences anxiety because of a fear
of drowning; previous frightening water experiences
such as inappropriate teaching, submerging unex-
pectedly and choking on water, capsizing in a boat,
or being knocked down by a wave; fear reinforced
by warnings (e.g., “Don’t go near that water or you
will drown!”); or feelings of insecurity caused by poor
physical ability or unfamiliar surroundings. Children
sometimes fear that their caregiver will not return for
them after class, and people with mobility problems
may fear that they will not be able to recover if they
slip underwater.
Fear stimulates neurological reflexes such as
heightened muscle tone, involuntary muscle move-
ment, avoidance behavior, and the inability to float.
Fear is a powerful emotion that lessens participants’
motivation and ability to learn. The ARC (2004b) lists
the following avoidance behaviors as being frequently
displayed by participants experiencing anxiety:
• Huddling (rounding the shoulders)
• Maintaining a rigid body
• Clenching fists
Figure 8.2  Fear affects the ability to acquire skills.
• Pursing or biting lips
• Shivering even in warm water
• Clinging to instructor or other supports
• Frequently requesting to use the bathroom
You must help participants get past fear and anxiety
so that they can practice the skills that will make them
water safe. When participants are free of fear, they are
free to learn. Consider implementing a formal or an
informal fear-reduction program. The following tips
for eliminating fear from the process of learning to
swim come from an article by Moran (1961) on fear
and aquatics instruction. In addition to reading this
article, you should read “Systematic Desensitization
of Aquaphobic Persons” by Hicks (1988).
• Do not ridicule or exhibit impatience with fear-
ful reactions.
• Use patience without pampering.
• Gently guide, don’t force.
• Explain everything in a calm, sympathetic
voice.
• Progress from step to step gradually.
• Use noncompetitive activities.
• Encourage practice of breath control at home.
• Allow time and place to diffuse emotion.

Motivation for Learning
Motivation can be defined as the “forces that cause
behaviors or the internal state that directs us toward
some goal” (Sherrill & Tripp, 2004a, p. 236). It can
be intrinsic or extrinsic. Individuals may partici-
pate in aquatics classes for any number of reasons,
including to improve skills, achieve personal goals,
compete against others, have fun, find excitement,
meet a school requirement, make friends, or please
significant others. You must seek out the actual rea-
sons that individuals are in your class and help par-
ticipants to set goals accordingly. Beware that when
individuals do not choose aquatics participation of
their own accord, their motivation to learn may be
nonexistent.
Cognitive Readiness
Cognitive readiness combines several factors, includ-
ing (a) the ability to understand directions relating
to aquatics instruction, (b) mental adjustment to the
aquatic environment, (c) preconceived ideas about
the class or swimming, and (d) selective attention.
The ability to understand directions is based on the
cognitive level of the participant and the cognitive
level of the directions you give. Thus, you must know
the developmental age of the participant in order
to appropriately gear instructions. Using pictures,
shorter sentences, and key words and phrases are
important strategies for teaching people with lower
mental ages. Make sure the participant understands
the words that you are using, as his movement
vocabulary may be limited—words such as bend,
straighten, twist, or roll may be foreign to a participant
with low cognitive ability.
The degree of mental adjustment determines
whether or not the individual is ready to learn. Not
surprisingly, fear and motivation play large roles in
mental adjustment. The ability to relax in the aquatic
environment depends on cognitively being aware of
safety and knowing when it is appropriate to be afraid.
For example, developing breath control often plays
a major part in mental adjustment, as good breath
control decreases fear.The total teacher–participant
environment is vital to overcoming difficulties (Cam-
pion, 1991). If you provide a consistent personality,
discipline methods that remain flexible but consistent,
caring verbal assurances, and balanced, controlled
physical handling to promote stable body position,
you will help promote trust, security, and mental
adjustment over time.
Negative preconceived ideas about the class or
swimming can render a participant helpless. Individu-
als may have heard previous participants complaining
about a particular instructor, program, or facility and
Instructional Strategies 167
may have carried such notions into the class with
them. Participants may also come with the burden
of horror stories they’ve heard about swimming in
general. “It increases body fat, promotes ear infec-
tions, and spreads infectious diseases” are common
pieces of gossip passed from one reluctant swimmer
to the next. But being the instructor on guard for one
reason or another is hardly conducive to learning. An
honest answer to questions that may appear ridiculous
is the best method of putting everyone at ease and
letting preconceived ideas die.
Selective attention can shape an individual’s abil-
ity to be cognitively ready for learning. You might
give clear directions that fit the correct mental age,
but if the participant cannot attend to the important
information, learning will be hampered. Extraneous
noise, people, and activities in the environment can
cause an individual with deficits in selective atten-
tion to retreat into her own world or look and listen
elsewhere. Often, you will not have the luxury of
teaching in a quiet area free of others. To cope with
this, give extra attention to cue words, offer praise
for being on task, and make activities exciting so
that participants with selective attention disorders
can remain focused on important teacher–participant
interactions (see also the teaching tips for the related
disorders in chapter 9).
Social Ability
Social ability, which is the ability to interact with
others, can play a role in learning aquatic skills,
especially if the participant attends class in a group
setting. Many individuals have the physical skills to
participate within inclusive aquatics classes but lack
appropriate social competence. The ability to function
within a group demands a social age of approximately
5 years. If an individual cannot, for example, wait for
turns, follow rules, start and stop on command, or
share, he will have a difficult time acquiring aquatic
skills within a group. The abilities to initiate contact
with others and make friends are also important in
an adapted aquatics group—as they are in any other
social setting. Individuals who have trouble judging
their personal best, who feel their own abilities don’t
measure up to those of others, or who are egocentric
may have great difficulty learning in group settings.
Some people (i.e., people with autism) cannot
establish a bond with a group, lack concern for others,
are manipulative, or exhibit aggressive behaviors.
Such conduct disorders interfere with a positive
learning climate and may decrease the amount of
learning that all participants achieve. Participants
who persistently exhibit behavior that interferes with
their learning process and that of others may need
168 Adapted Aquatics Programming
specific behavior intervention, a learning support
aide, or removal to a more restrictive environment
where they can calm down.
Preferred Learning Modality
The way participants process and use information
can affect how much they learn. You should match
your instructional method to that which best suits
a person’s distinct characteristics in order to have a
more effective outcome (Snider, 1990). This theory
is called learning style matching. There are two con-
siderations to be made when matching. First, you
must know the student’s preferred learning modality.
While every student processes information visually,
auditorily, and kinesthetically, every student also
prefers one method over the other two. Second, you
must choose a teaching style that best facilitates the
goals of the lesson you are presenting (Mosston &
Ashworth, 2002).
The general tenet of matching instructional strate-
gies to learning styles recommends that you recognize
and accommodate individual differences in learning.
Present materials in a variety of ways designed to
address all participants, and then stick with the style
that works. Placing participants into one learning
style category, depending on disability or mental age,
however, is unreasonable. You should create a myriad
of opportunities for participants to learn by enhancing
instructional presentations with visual, verbal, tac-
tile, and kinesthetic input as well as by using direct,
indirect, small-group, one-on-one, structured, or less
structured methods. Using a variety of teaching strate-
gies gives all participants the chance to develop the
Figure 8.3  Cultural aspects may affect learning.
ability to receive information in several ways, whether
or not these ways match their preferred style.
Cultural values can also influence a participant’s
learning style (see figure 8.3). While learning swim
skills is considered valuable in American culture,
other cultures might value other culturally determined
forms of movement, such as soccer, ice hockey, and
wrestling. Cultures that do not permit extensive eye
contact or staring may have problems with visual
demonstrations. Students from cultures that man-
date wearing head coverings in public may not be
able to participate fully in swimming. People who
are deaf because of their cultural background (the
Deaf culture) may require you to use American Sign
Language rather than signed English. Individuals
who are Orthodox Jews may need separate-gender
classes. “The key issues are people are different,
participants will respond differently to a variety of
instructional methods, and we need to respect and
honor the individual differences among us” (Brandt,
1990, p. 12).
Teaching, Facilitating, and
Guiding Participants
Remember that successful adapted aquatics instruc-
tors not only provide the opportunity to learn but
also help participants acquire swimming and safety
skills. The instructor must know the content involved
in teaching swimming and water safety and be able
to plan and implement a delivery system that results

in learning. In writing this section of the chapter,
we have assumed that you have expertise in water
safety instruction and its content. Instead of covering
basic water safety instruction, we focus on design-
ing and delivering more creative, comprehensive,
and thoughtful instruction when a group includes
individuals with disabilities.
Instructional Design
You must properly plan, sequence, and organize
instructional experiences to meet the needs of the
participants in the aquatics group, using strategies
that meet the needs of all students. As an adapted
aquatics instructor, you can help regular aquatics
instructors modify traditional strategies to be more
individualized and inclusive. In this section, we’ll
look at several successful modifications and strate-
gies you can use.
In teaching aquatic skills to individuals with dis-
abilities, especially in a group situation, you must
make decisions before, during, and after every lesson
(Mosston & Ashworth, 2002). As mentioned in chapter
4, instructional design begins with determining the
assessment criteria and procedure. Following the
assessment, you must outline learning objectives
and prepare an individualized plan before beginning
instruction. The third part of the design phase is pre-
paring the instruction itself, including selecting teach-
ing style, developing strategies for lessons (individual
or group), modifying activities, and sequencing the
learning experiences to maximize learning.
Teaching Styles
Mosston and Ashworth (2002) delineate 11 differ-
ent teaching styles: command, practice, reciprocal,
self-check, inclusion, guided discovery, convergent
discovery, divergent discovery, learner-designed
individual program, learner-initiated, and self-teach-
ing. Each style has a specific role for teacher and
participant, and depending on what you wish to
accomplish in a given lesson, you must choose a
style to facilitate the learning process. In this section
we briefly examine each of these styles in relation
to adapted aquatics in order to provide you with a
variety of ways to introduce skills and to help you
find what works best with each participant. If one
style doesn’t work, simply try another.
Command Style
When utilizing command style the teacher makes
all the decisions and the participant executes the
performance decisions on cue. As the teacher you
want your participants to know the expectations of the
task performance, and therefore you are responsible
Instructional Strategies 169
for stating the expectations during every movement.
Use this style when you want all participants to per-
form and look the same—as, for example, in drills
in which you direct the swimmers to concentrate on
a particular aspect of a stroke and have everyone
perform that stroke in the same manner (“with elbows
like this”). Adapted aquatics instructors have used
command style successfully with individuals who
have severe mental retardation, learning disabilities,
emotional disturbances, pervasive developmental
delays, hyperactivity, and distractibility, because with
this style the teacher maintains control in a uniform
and consistent way.
Practice Style
Practice style allows the teacher time to offer each
participant private practice and individual feedback. A
shift occurs from the teacher making decisions about
a participant’s performance to the participant making
decisions about her own performance—including
when she makes the decisions that will direct her
performance. Practice style may be less stressful than
command style for the participant because it avoids
situations in which the participant may compare
herself to others. In practice style, the participant
practices not only the task but also the process of
making decisions. The teacher has to learn to trust
the participant to make appropriate decisions while
practicing and while learning to develop independent
decision-making skills. But a participant learning by
practice style must know how to stay on task and
must value practice time as he begins to feel some
independence. You can use laminated index cards
with words on one side and a picture of the skill on
the other side to guide the participant during prac-
tice. You can give easier and harder directions on the
card as well. You may need to demonstrate all the
skills on the cards at first to ensure that the swimmer
understands the directions. You can use this style
effectively with individuals who can interpret words
or pictures, such as people with memory loss due to
traumatic brain injury.
Reciprocal Style
In reciprocal style, there is more social interaction.
The participants work with a partner and provide
feedback to each other based on very specific cri-
teria prepared by the aquatics instructor. The sub-
stance of this style is that the participants work in
a partnership, receive immediate feedback, follow
criteria for performance designed by the teacher,
and develop feedback and socialization skills. Indi-
viduals taught by this style must be knowledgeable
enough to compare peers’ performances to criteria,
have the ability to communicate, and have some
170 Adapted Aquatics Programming
patience with and tolerance of others. Laminated
skill sheets with task-analyzed swim skills along
with grease pencils for writing on the lamination
and clipboards or hard surfaces help facilitate the
feedback process. You can use the reciprocal style
effectively with individuals who understand com-
munication, can give and receive feedback, have
enough comprehension skills to compare partners’
performances to performance criteria, and who
properly socialize with others.
Self-Check Style
The characteristics of self-check style are performing
a task independently and self-assessing the work. The
participant does the task individually and privately
and then gives herself feedback by using criteria pre-
viously developed by the instructor. Thus, this style
enhances the development of independence. The
individual must be able to accept her own limitations,
be honest and objective about her performance, and
be able to use a self-check sheet. The instructor should
first design the self-check sheet, altering performance
criteria to meet the individual’s specific needs. To do
this, observe the swimmer, task-analyze the stroke and
decide what should be modified, and type or write
your resulting criteria on an index card. Laminate
or place this card in a plastic zip-style bag and tape
the card by the starting blocks or lay it over the pool
gutter. While the self-check style is not appropriate
for participants with low cognitive ability or poor
sensory integration, kinesthetic sense, or judgment,
it is useful for participants with good cognition who
prefer social isolation.
Inclusion Style
The purpose of inclusion style is to have participants
with varying skill levels participate in the same activ-
ity while self-selecting their own level of difficulty.
To use this style, the instructor must design a task to
include different degrees of difficulty. The participant
picks an individual entry point into the task, practices
the task, and then moves to the next level according
to the criteria prearranged by the instructor. Inclusion
style is especially effective with an integrated (inclu-
sion) aquatics class. For example, during this class
you can present a task such as swimming underwater
through hoops submerged at various depths. The
participant picks the hoop that he will be successful
with but challenged by. Participants must already have
some degree of independence and be able to choose
which level to work at. The difficulty with this style
is that you must allow the participant to choose the
level for himself, resisting the urge to impose what
you would choose for him.
Guided Discovery Style
In guided discovery, the participant discovers a con-
cept by answering a series of questions the instructor
presents. The instructor asks a specific sequence of
questions, systematically leading the participant to
discover a predetermined target previously unknown
to the participant. This style is good for students who
cannot perform to a particular performance standard
but have the cognitive ability to explore alternative
ways of answering a question. You might ask, “In what
ways can you swim to the bottom of the pool with
your hands leading you to pick up the diving rings?”
or “How can you swim the breaststroke without let-
ting your feet come out of the water on the kick?” The
problem-solving method of the guided discovery style
lets participants discover the movement patterns most
efficient for themselves. Participants must have suffi-
cient cognitive ability to follow directions and attempt
the task at hand. This style is good for the inclusion
of students with mild physical disabilities, mild cog-
nitive delay, or health impairments that prohibit the
exact replication of specific performance criteria. In
addition, the guided discovery style is very good for
discovering balance, buoyancy, stability, and initial
propulsion in aquatics.
Convergent Discovery Style
In the convergent discovery style, participants dis-
cover the solution to a problem and learn to clarify an
issue and arrive at a conclusion by employing logic,
reasoning, and critical thinking. In the initial step of
this style, the instructor makes decisions on subject
matter, choosing the correct response to be discov-
ered and a single question to ask the participant. The
instructor might ask, “Where is the best place for the
hand to be in order to reduce drag?” or “When is the
best time for breathing to begin in the crawl stroke?”
The participant, using logically sequenced connec-
tions, must determine the answer. Participants must
have a high degree of independence, problem-solving
skills, intellect, and motivation to find the solution.
Use this style with groups learning safety information,
synchronized swimming, competitive swimming, or
routines in water aerobics.
Divergent Discovery (Production) Style
In contrast to the convergent discovery style, the
divergent discovery style produces divergent (mul-
tiple) responses to a single question or situation. In
this style, you set the scene, making sure that the
emotional climate is OK for participants to take risks
and come up with solutions; then participants make
responses based on the parameters you have set. This
style is useful when presenting water safety informa-

tion to groups and safety rules for individuals with
mild cognitive delays or normal cognition. You might
ask, “What are some pool rules we should follow?”
and “What are ways we could go across the pool
with a partner that are not standard swim strokes?”
This style is good for participants who can come up
with novel ideas, such as creating movements in the
water for the simple pleasure of moving. This style is
too open and depends too much on cognitive skills
and awareness to be useful for participants with little
initiative, poor judgment, severe cognitive problems,
or hyperactivity.
Learner-Designed Individual Program Style
In learner-designed individual program style, the
participant designs, develops, and performs a series
of tasks organized into a personal program in con-
sultation with the instructor. The instructor selects
the general subject area (e.g., cardiorespiratory
health) while the participant selects the topic (e.g.,
aerobic work), identifies the questions (e.g., “What
aquatic moves produce high heart rates?”), collects
data (e.g., experiments with different moves and
writes down heart rate following each), discovers
answers (e.g., compares heart rates and moves), and
organizes the information (e.g., records daily heart
rate on a graph). The participant has more liberty to
discover solutions or movements and to designate
the performance criteria. This style requires highly
disciplined, highly motivated participants with high
cognitive ability, especially when the style is used in
fitness or competitive programs. Participants must be
relatively skilled, able to make long-range plans, and
willing to take on a challenge. Participants may need
to research physical training or review other training
routines to collect data about the topic and organize
information to achieve their goals.
Learner-Initiated Style
Learner-initiated style helps the participant initiate,
design, perform, and evaluate a learning experience,
together with the instructor, based on agreed-upon
criteria. In this style, a participant approaches the
instructor and states her willingness to design a
program for self-development. The instructor’s job
is to provide feedback about whether or not the
participant’s actions are matching her intentions.
For example, the participant might be coaching
herself but may need some feedback once a month
about stroke techniques, turns, and timing of swim
strokes. Learner-initiated style works with individuals
who have self-initiated goals, usually in the fitness
or competitive category, and need only occasional
observation by the instructor or coach.
Instructional Strategies 171
Self-Teaching Style
The self-teaching style allows the participant to make
all the decisions without any instructor involvement.
The participant himself assumes the role of the
instructor, making all the decisions from initiating,
designing, and performing to evaluating the learning
experience. Although it is possible for a participant
to choose this style, self-teaching usually does not
occur in the aquatic setting unless the participant is
a longtime swimmer who decides to begin training
on his own.
Developing Strategies
When you develop strategies for group and individual
lessons, you must focus on the appropriate interaction
of the teaching–learning style and the interaction of
the participant with environmental influences. For
example, the instructor may be teaching a student
through the student’s learning style (auditory), but
background music in the pool area (environmental
influence) is too distracting for the student to be
able to concentrate. Figure 8.4 provides examples of
matching learning style with teaching style, resulting
in learning by the participant.
The more time the student spends appropriately
engaged in the content you are teaching, the more she
will learn. Strive, then, for maximizing active learning
time (ALT) with all students, particularly those with
intense learning or physical needs. ALT is “the amount
of time that a student spends engaged successfully
in activities related to the objectives” (Siedentop &
Tannehill, 2000, p. 24). Student learning correlates
strongly with the amount of accumulated ALT. When
you include individuals with disabilities in regular
group instruction, you must be especially aware of
the time you allot for instruction and the time the
participants are truly and fully engaged in practicing
the objectives. Thus, you must use effective strategies
to ensure that the individual with the disability is on
task at the appropriate level and with the support
necessary for success. In other words, practice that
is too easy or too hard does not enhance the learning
of aquatic skills.
You can use a variety of instructional strategies to
help participants who cannot perform a skill in the
same way or at the same level as others in the group
perform it. To find ways to teach aquatic skills while
incorporating individuals with varying needs requires
you to focus on several factors, including the age of
participants; the instructor-to-participant ratio; the
cognitive, social, and physical abilities of participants;
your experience with group management; and safety
issues (Auxter et al., 2005).
172 Adapted Aquatics Programming
Learning style
Modality
Visual, auditory, kinesthetic, tactile
Setting
Individual, group
Structured, informal
Sociocultural familiarity
Stimuli and responses
Social, cognitive, emotional
Challenging, supportive
Self-directing
Methods
Guided
Self-teaching
Figure 8.4  Instructional matching. E3344/Lepore/fig.8.4/278201/alw/r2
When designing an aquatics lesson for a group or
an individual, you must sequence the instructional
strategies and the presentation of skills from general to
specific (begin with full-body feedback and progress
to feedback on hand and wrist positions) and from
simple to complex (progress from front glides to front
glides with kick and arm motion), building on any
necessary prerequisites. You also need to include
alternative activities, cue words, and presentations
as needed. The sample group lesson in the sidebar
on page 173 demonstrates the relationship between a
participant’s individualized program plan and a group
lesson. In this example, Raquel has spina bifida with
paraplegia, is 20 years old, and is participating in a
college’s basic swimming class. In the sample lesson,
she participates with the group while still working
on her goals through modified activities and related
adaptations.
Teaching style
Command: Do it like this, now!
Practice: One more time!
Reciprocal: Iʼll help you and you
help me!
Self-check: I did it the way you
told me to!
Inclusion: Try it this way even though other
swimmers are doing it other ways!
Guided discovery: How can you swim to the
bottom using your hands, to pick up the ring?
Convergent discovery: When do you turn
your head to breathe?
Divergent discovery: What are the pool
rules?
Learner-designed individual program:
How can you elevate your heart rate?
Learner-initiated: Is this the technique we
agreed on?
Self-teaching: If you need me, let me know!
See chapter 3 for more details on how to include
participants with disabilities in aquatics lessons, and
see chapter 9 for teaching tips specific to a variety
of disabilities.
Instructional Delivery
In this section, we suggest how to move instructional
strategies and creative solutions from the planning
(preimpact) stage to the implementation (impact)
stage through instructional delivery skills. The discus-
sion also includes information on using qualitative
teaching cues.
Instructors need to help participants connect with
the information, or the information does not become
a lasting part of them (Guillaume, 2004). When a gap
exists between instructional planning and instruc-
tional delivery in aquatic classes, it is most likely
Integrating the IAPP and Group Lesson
Raquel’s IAPP
Present Level of Performance
Raquel is a young adult with good upper-body
strength and endurance and no use of her lower
trunk and lower extremities. She is in a basic swim
and fitness class at the university and functions
at level 4 (Stroke Development) of the ARC pro-
gressive swim program.
Long-Term Goals
❚ To use swimming as the means to improve
cardiorespiratory fitness
❚ To develop competitive, fitness, and relax-
ation strokes
❚ To improve water safety skills and knowl-
edge
❚ To maintain current range of motion in
lower extremities
❚ To increase trunk rotation and upper-body
range of motion
Sample Group Lesson
An aquatics instructor, with an adapted aquat-
ics instructor as coinstructor, will lead the lesson.
After a few weeks of guidance from the adapted
aquatics instructor, the aquatics instructor should
be able to operate alone.
Group Lesson Goals
To improve fitness and swim stroke efficiency
Group Lesson Objectives
❚ Wall stretches, 3 minutes
❚ Treading water, 5 minutes
❚ Open turns on front, three correct in a row
❚ Kickboard presses, 2 minutes consecutively
during fitness routine
❚ Aerobic fitness routine, 12 minutes
❚ Continuous swimming, 5 minutes
❚ Improving swim strokes to ARC level 5
❚ Water-walking, two lengths of pool
Group Lesson Timetable
University Swim 101, Tuesdays and Thursdays   like she did for the warm-up,
12 to 1 p.m.
12:00 to 12:05 Water-walking with pumping
arms as a warm-up for the
fitness routine. Raquel will use
the water bench to perform
continuous trunk rotations
while alternately punching
arms out in front; she will
need assistance to maintain
balance.
12:05 to 12:10 Treading water. Raquel will
use the Wet Vest and her
arms for the sculling motion
of treading water.
12:10 to 12:15 Stretching lower legs and
arms. Raquel will per form
arm stretches while sitting on
the water bench, with assis-
tance for balance. The APE
or adapted aquatics instruc-
tor will come in to assist with
lower-body flexibility exer-
cises. Or Raquel will continue
treading water, concentrating
on large arm movements, or
will use inner tube to perform
stretching exercises.
12:15 to 12:20 Fitness swim. Raquel will per-
form modified breaststroke
and elementary backstroke
at her own pace.
12:20 to 12:32 Fitness routine. Raquel will
perform a modified routine
while using a ski belt to stay
vertical. Raquel can do some
legwork by manipulating her
own legs; for example, she can
use her hands to push down
her legs. She may substitute
arm actions for leg actions of a
similar nature. The instructor will
brainstorm with Raquel and the
adapted aquatics instructor
before modifying the routine.
12:32 to 12:55 Stroke work. The adapted
aquatics instructor on com-
pensation for leg action will
give Raquel feedback.
12:55 to 1:00 Water-walking and stretch-
ing. Raquel will cool down by
using the elementary back-
stroke and then stretching
emphasizing shoulder and
upper-trunk stretching. Since
she is able to bear some
weight, the instructor can
assist her in the pool by pro-
viding support or Raquel can
use a flotation device.
173
174 Adapted Aquatics Programming

wider for individuals with disabilities than it is for
people without disabilities. For example, if you use
water baseball as a strategy for increasing the partici-
pants’ comfort with moving around in shallow water
but fail to identify the social, cognitive, and physical
skills needed for playing baseball, several students
will never engage in the activity. Students without
disabilities may not have any catching or striking
skills, but they can still run or walk to the water bases.
In contrast, individuals with disabilities (e.g., with
severe cerebral palsy) may not be able to perform
any of the skills, including walking. To help close the
gap between design and delivery, first examine the
elements of effective instruction. See figure 8.5 for a
visual representation of the input and planning steps
that lead to individualized skill instruction and the
development of stroke adaptations.
In addition to having interaction skills, you must
use the basic elements of effective instruction in order
to enhance learning opportunities for individuals
with disabilities. These elements include selecting
student-centered objectives at the appropriate level
of difficulty, teaching to those objectives, monitoring
participants’ progress, modifying instruction when
necessary, using principles of learning to direct les-
sons (Hunter, 1994), giving clear directions, engaging
all in active participation, giving continual feedback,
and managing behavior. Chapter 4 included infor-
mation on selecting objectives, teaching to those
objectives, and monitoring participants’ progress. We

Input and planning steps

Stroke mechanics
Head and body position
Arm and leg movements
Breath control
Coordination
Propulsive and glide phases

What’s the skill or stroke objective Continued modification and

and what’s required to get there? adaptation to achieve skill

What can the swimmer do that How will the swimmer explore and
approximates the desired skill? develop new functionality?

What’s the swimmer’s current ability; What’s the logical learning

what’s to be developed? progression to develop the skill?

Hydrodynamic principles
Process of learning Specific gravity Process of accomplishing
Physiological factors Buoyancy (CB, CG) goals
Psychological factors Resistance forces Instructional design
Culture Laws of motion Instructional delivery
Water temperature Adapting strokes
(see chapter 7)

Figure 8.5  Using this flowchart will help you individualize skill instruction and adapt swim strokes.
E3344/Lepore/fig.8.5/280875/alw/r3
 Instructional Strategies 175

discussed using principles of learning to direct lessons
earlier in this chapter. The following section addresses
the other elements of effective instruction.
Modifying Instruction
Many times an instructor is required to modify lesson
plans, whether teaching in a segregated or an inte-
grated setting. The ability to modify lessons while
in the act of teaching is an additional skill that is
sometimes called thinking on your feet in pedagogi-
cal circles. The best way to shift gears on the spur
of the moment is to have alternative plans available
for immediate implementation, including plans for
adjusting your style and strategies. When the lesson
is not going well, don’t fall into the common trap of
muddling through as planned; instead, identify prob-
lems and make quick but prudent modifications. Keep
in mind that while aquatics classes for participants
without disabilities might proceed satisfactorily (but
not succeed) without changes in plans, individu-
als with behavior problems, physical comfort and
safety needs, or disorientation are at risk for injury
if necessary modifications are not made. How do
you know when to change course? The participants
communicate this message in numerous ways! Try
a new strategy when a participant or equipment is
being mistreated; when emotional comfort is low,
as demonstrated through teasing, ignoring, yelling,
criticizing, or controlling others; when participants
are practicing but not doing their best; when parents
or caregivers are intervening; when the group is too
spread out; when individuals are climbing out of the
pool; or when participants are crying or whining.
When these things happen, quickly judge the situ-
ation and make corrections. Ask yourself, “Was the
teaching style too participant driven for the group or
the individual to handle? Was the equipment too large
or too small? Are participants spending too much
waiting for turns and attention? Is the class size too
large for the abilities of the students? Are the partici-
pants working at their own levels or trying skills that
are too easy or too hard for them?”
The participants signal to you that it’s time for a
‘Marco Polo,’ please swim to me.” Often merely
changing to the next activity will reorganize the class.
After the lesson (postimpact), examine what went
wrong and plan the next lesson with new insight!
You may also need to adapt verbal and visual
demonstrations on the spot. Doing this includes
learning sign language to use with individuals who
have impaired or no hearing or who have language
disorders. Visual demonstrations are useful in com-
municating information as long as all participants
can see and are focused and the demonstrations are
presented at the appropriate speed. Individuals with
attention problems often need help refocusing during
demonstrations. Individuals who have physical dis-
abilities may find it difficult to maneuver to a spot
from which they can view the entire demonstration,
and individuals with visual impairments may require
alternative (tactile, kinesthetic, auditory) methods of
receiving directions. Figure 8.6 gives an example of
demonstration modifications.
Giving Clear Directions
Giving clear directions will help a group or individual
stay focused on the activity at hand. The following tips
will help you deliver your instructions more clearly:
• Use a participant’s name (respectfully) when
directing a specific comment.
• When telling participants where to go in the
pool, mention landmarks. For example, tell the
Photo courtesy of Camp Abilities Tucson

change. “Now what?” you may ask. Calmly bring

the group in close, redirect them, and move on to
another part of the lesson or substitute another, more
appropriate activity. Setting a prearranged signal for
the respectful reassembly of the class during the initial
meeting with the group is a positive and proactive
strategy for addressing problems. Use signals such
as, “When I am sitting on the pool deck, that means
come over quickly,” “When I wave both hands over
my head, please swim in to me,” “When I shout Figure 8.6  Swimmers who are blind need to feel a
‘icebergs,’ stand still for directions,” or “When I shout demonstration.
176 Adapted Aquatics Programming
participant to “swim to the ladder” instead of
“swim over there.”
• Use simple sentences that tell the participant
what to do without added verbiage.
• Give one set of directions at a time.
• Repeat key points of directions when needed.
• Check for understanding by asking participants
questions such as, “Where will you stop?” or
“How many laps will you do?”
• Provide signed or tactile directions for those
who need you to do so.
Selecting Cues
An essential component of presenting aquatic skills
is selecting cues. A cue is a word or phrase that com-
municates to a participant the critical features of a
movement skill or task (Rink, 2006). As an aquatics
instructor, you will teach your participants for brief
amounts of time during the week. All instructors and
staff should utilize an appropriate number of cues
that are accurate and qualitative.
Cues combined with visual demonstrations
assist participants in developing vivid images of the
aquatic skill, resulting in greater performance gains.
However, participants, especially those with cogni-
tive or behavior issues, process a limited amount of
information. Resist the temptation to progress too
rapidly or present too much information at once, as
your participants will be confused and overwhelmed.
Teaching too quickly leads to heightened frustration
for you and your participants and results in little or
no progress.
For each skill, practice the whole skill, but focus
on each of its components in turn. Provide only 1
or 2 cues at a time. Once the participants acquire
the component targeted by the first cue, such as
making a heart shape with the hands for swimming
the breaststroke, move to the next phase of the skill.
Participants with congenital visual impairment may
lack an intrinsic picture of what a heart looks like.
Therefore, this is a good time to simultaneously com-
bine a verbal cue with brailling. Brailling refers to a
participant using her tactile senses in learning. When
brailling, the participant uses her hands to examine
the position and movement of the instructor’s body
or limbs as the skill is demonstrated (Lieberman &
Cowart, 1996). Subsequent cues should build on
previously learned skills. Provide only short pieces
of information that the participant can quickly apply
to the aquatics skill (Fronske, 2001). See table 8.1 for
specific cues for swimming strokes and skills.
Engaging Students in Active Participation
No matter how well you demonstrate and explain
while teaching, if the participant does not have
enough time to practice the skills necessary for learn-
ing the objective, he will not learn to his full potential.
In an inclusion group, participants with disabilities
may not actively participate very often because they
have behavior problems, lack appropriate physical
support, or do not possess adequate prerequisites for
the skill or experience. You must see the big picture,
make accurate initial placements, plan lessons effec-
tively, and deliver them well so that all participants are
successful. You must be patient and caring to carry out
the elements of effective instruction, applying both
your knowledge of safety issues related to individuals
with disabilities and your creative methods of adapt-
ing activities and instruction.
Giving Continual Feedback
The most important contribution to a participant’s
practice is instructor feedback. The feedback should
be timely, appropriate, and specific in order to let
participants know how they are doing. This feedback,
both positive and negative, may be in response to
social behavior or physical performance. Social feed-
back can be given for waiting, listening, following
directions, trying hard, being on time, not crying or
whining, or interacting appropriately with the group.
Physical performance feedback falls into two cat-
egories: knowledge of results (KR) and knowledge of
performance (KP). KR is associated with information
about the outcome of a skill or about achieving the
goal of the performance (Magill, 2001; Rink, 2006).
Examples of KR include, “Great, Nisha, you walked
across the width of the pool!”; “Terrific, Tristen, you’ve
completed five laps!”; and “Nice work, Courtney, you
were able to meet your goal of jumping into the deep
end four times today!” Giving positive feedback can
also help spur a participant toward a goal, such as,
“Almost, Michael, you treaded water for 4 seconds;
now let’s try to tread water for 5 seconds and don’t
forget to keep your hands in the water as you move
them back and forth.” Note that even the corrective
feedback is positive and begins with a compliment,
encouraging the participant.
KP includes comments, gestures, or signs about
movement execution. Work on the most crucial
aspects of the movement first, the ones that will make
a large difference if corrected. For example, correcting
the body position is of greater concern than correct-
ing the angle of the wrist. Examples of KP include,
“You were much faster because you kept your body
 Table 8.1

Teaching Cues for Sport Skills

Note: Due to rights limitations, this item has been removed.

The material can be found in its original source.
From TEACHING CUES FOR SPORT SKILLS, 2nd ed.
by Hilda Fronske. Copyright © 2001 by Allyn and Bacon.

(continued)

177
 Table 8.1  (continued)

Note: Due to rights limitations, this item has been removed.

The material can be found in its original source.
From TEACHING CUES FOR SPORT SKILLS, 2nd ed.
by Hilda Fronske. Copyright © 2001 by Allyn and Bacon.

178
 Instructional Strategies 179

horizontal that time” and “Great arm stroke, but keep
your head turned more to the side instead of lifting it
to the front when you breathe.”
KP comments are much more difficult to give, but
individuals with poor sensory feedback, low cognitive
awareness, or limited experience in the water need
immediate specific feedback in order to progress.
Participants obtain information on both KR and KP
internally from sensory information, such as auditory,
visual, and kinesthetic information, or externally from
others, such as the instructor and aide. Participants
can hear the results, see the results, or feel the results
(through their movements). Always remember to
provide feedback in the participant’s preferred com-
munication mode and at his level of understanding.
Stroke Modifications
As previously discussed, participants with disabili-
ties often progress slowly, demonstrating immature
skill patterns. Each person is unique, demonstrating
aquatic skill proficiency commensurate with her
personal philosophy and physical ability. Often,
swimmers with disabilities require stroke adapta-
tions for successful participation in functional recre-
ation, fitness, or competition activities. The physical
requirements for aquatics participation are specific
to the mode of each activity. However, one thing is
certain: Most participants with disabilities require
some stroke, kick, or rule modification, whether
swimming in the local community recreation facility
or engaging in international competition. See table
8.2 for suggestions on how to adapt stroke techniques.
These suggestions are based on research with elite
swimmers.
After the instructor has conducted an assessment,
the results should be used to determine the most
functional mechanics to pursue and the participant’s
personal goals (Lepore, 2005; Sherrill & Dummer,
2004). However, the time will quickly come when
the participant realizes that the traditional mechanics
of a stroke or kick are impossible or so inefficient that

Table 8.2

Adaptations of Stroke Techniques for Swimmers With Disabilities

Note: Due to rights limitations, this item has been removed.

The material can be found in its original source.
From C. Sherrill and G. Dummer, 2004, Adapted aquatics. In
Adapted physical activity, recreation and sport:
Crossdisciplinary and lifespan, 6th ed., edited by
C. Sherrill (New York, NY: McGraw Hill), 473-475.

(continued)
 Table 8.2  (continued)

Note: Due to rights limitations, this item has been removed.

The material can be found in its original source.
From C. Sherrill and G. Dummer, 2004, Adapted aquatics. In
Adapted physical activity, recreation and sport:
Crossdisciplinary and lifespan, 6th ed., edited by
C. Sherrill (New York, NY: McGraw Hill), 473-475.

180
 Note: Due to rights limitations, this item has been removed.
The material can be found in its original source.
From C. Sherrill and G. Dummer, 2004, Adapted aquatics. In
Adapted physical activity, recreation and sport:
Crossdisciplinary and lifespan, 6th ed., edited by
C. Sherrill (New York, NY: McGraw Hill), 473-475.

181
182 Adapted Aquatics Programming
pursuit will not serve him well. Important consider-
ations in adapting strokes include the following:
• What are the physical constraints of the dis-
ability?
• What is the most efficient way to propel through
the water, given the constraints?
• What movements will cause or diminish pain
or injury?
• What adaptations can be made that will make
the stroke or skill as much like the nonadapted
version as possible?
• What equipment is available to facilitate the
skill?
• What is the reason that the swimmer wants to
learn the skill?
When modifying swim strokes, the instructor
might need to
• adjust the swimmer’s body position by adding
flotation with light weights,
• change the propulsive action of the arms or
legs, or
• adapt the breathing pattern.
Adjusting body positioning for participants with
disabilities such as cerebral palsy, stroke, spinal cord
injury, spina bifida, or obesity is warranted. Variations
in muscle mass and tone often result in an atypical
center of buoyancy. Experimentation with flotation
devices, weights (e.g., scuba diving), PFDs, or noodles
may help streamline body position and remedy the
buoyancy issue.
Propulsive actions may be affected by conditions
including muscle atrophy, muscle contraction, ampu-
tation, and dwarfism and thus may require modified
stroke patterns or the assistance of propulsive devices
such as fins and hand paddles.
Breathing patterns may also need to be altered
by having the participant roll to the back to breathe,
breathe on alternate sides, or use explosive breathing
performed through the mouth only. Other adaptations
may include traditional and ecological task analysis;
verbal, visual, and tactile cues; and modified stroke
performance.
Addressing Problem Behaviors
A successful and effective aquatics program should
employ appropriate behavior management tech-
niques. Managing an individual’s behavior keeps
the person on task, thereby increasing learning time.
Managing group behavior prevents injuries, facilitates
positive social interaction, and creates an environ-
ment in which all participants can learn.
Formal Behavior Modification
As part of an interdisciplinary treatment team, aquat-
ics personnel may be involved in, although not origi-
nate, an individual’s behavior modification program.
Some participants may be involved in a systematic
treatment program to modify or reinforce targeted
behaviors. Such a behavior modification program is
designed by a professional trained in behavior man-
agement and must be consistent among everyone
(e.g., classroom teachers, therapists, family members)
helping to modify behavior. Consider behavior modi-
fication as a treatment intervention that differs from
other, less formal behavior management techniques,
which we’ll describe in the next section.
Applied Behavior Analysis
You should think of behavior as anything a person
does that is observable. One of the greatest challenges
confronted by an adapted aquatics instructor is help-
ing a participant maintain behavior that enables her to
learn. Remember, a participant who is nonresponsive
or out of control is nonteachable, and so learning
does not occur.
While the definitions of applied behavior analy-
sis (ABA) are reported formally and informally, all
share the same tenets. A formal definition reads as
follows: “The science in which procedures derived
from the principles of behavior are systematically
applied to enhance socially significant behavior to a
meaningful degree and demonstrate experimentally
that the procedures employed were responsible for
the improvement in behavior” (Cooper, Heron, &
Heward, 1987, p. 14). Chance (1998, p. 58) defines
ABA as “the attempt to solve behavior problems by
providing antecedents and/or consequences that
change behavior.” Loovis (2005) correctly states that
the process of implementing a behavioral system
requires reasonably strict adherence to several well-
defined steps. The behavioral system includes the
following sequential steps:
1. Select, define, and prioritize the target behavior
(Lavay, French, & Henderson, 2006).
2. Observe and record the behavior.
3. Implement the behavioral intervention.
4. Evaluate the behavioral intervention.

Select, Define, and Prioritize Behavior
The first step in the behavioral approach is identifying
a measurable target behavior that needs to be modi-
fied. The behavior should be observable and objec-
tively identified. Decisions for prioritizing behaviors
should be guided by the
• type of behavior,
• frequency of behavior,
• duration of behavior,
• intensity of behavior, and
• overall number of behaviors needing modifica-
tion (Loovis, 2005; Walker & Shea, 1999).
A beginning adapted aquatics instructor should not
attempt to change more than one individual or group
behavior at a time. A target behavior may be an exist-
ing behavior that the instructor or parent desires to
change or a nonoccurring behavior. A nonoccurring
behavior is a desired behavior that is not observable
in the participant’s repertoire and thus needs to be
developed. The target behavior is usually defined in
collaboration with the participant, aide, or parent.
Stating that your student is noncompliant is not suf-
ficient. You should describe what the student is doing
to be considered noncompliant—for example, “John
refuses to enter the pool via the ladder” or “Tamika
refuses to lift her feet off the pool bottom while in
shallow water.”
Observe and Record Behavior
The second step in the behavioral approach involves
gathering quantitative baseline data. This process of
collecting baseline data is often referred to as func-
tional analysis or functional assessment. Functional
analysis determines the driving forces or motivators
underlying a behavior and includes systemically
altering the antecedents to and consequences of the
behavior to confirm those driving forces (Seaman,
DePauw, Morton, & Omoto, 2003). Antecedents
are environmental events or cues that occur before
a behavior, while consequences are immediate
feedback (reinforcers) to a behavior that increase
or decrease its occurrence. A consequence can be
a reinforcement (causing a behavior to increase), a
punishment (causing a behavior to decrease), or a
time-out (ignoring inappropriate behavior, removing
the participant from a reinforcing environment, or
withholding reinforcers) (Sherrill, 2004). The instruc-
tor should closely observe the participant and look for
patterns of behavior in the natural environment (Lavay
et al., 2006). Let’s say that John’s teachers or parents
state that his refusal to enter the water “happens all
Instructional Strategies 183
the time.” However, after you begin your functional
assessment and observe John’s behavior over several
lessons, you determine that he only refuses when
there is a group of other students at the bottom of
the ladder.
Observing and Recording Behavior Rates  There
are several ways of counting, or recording, behavior,
including event recording, continuous (duration)
recording, and interval recording.
• Event recording. Record the number of times
that a behavior occurs (i.e., record the frequency
of the behavior) during a defined time period. For
example, count the number of breaths taken during
a front crawl in a 3-minute drill.
• Continuous (duration) recording. Record the
number of times or length of time that a behavior
occurs during a prescribed period. For example,
measure the amount of time a student is on task and
correctly performing the back float during a 5-minute
practice session. Convert the results into percentages
by dividing the total amount of time successfully spent
practicing the desired behavior by the total perfor-
mance time available. For example, a participant who
correctly performs the back float for 3 minutes during
the 5-minute practice session is on task 60% of the
time (180 seconds ÷ 300 seconds = .60).
• Interval recording. Record whether a behavior
occurs during each of a series of short intervals (5-20
seconds) within an observation period. For example,
observe once every 5 minutes if a student is on task
and correctly swimming a front crawl during a 30-
minute class (you will observe a total of 6 times). If
you observed the participant correctly attempting the
front crawl 3 out of 6 times, the student was on task
50% of the time (3 ÷ 6 = .50).
Observer Reliability  Successful application of the
behavior change process depends on the reliability
of the observations of the target behavior. Unreliable
measurements result in changed behaviors being
recorded as unchanged and in unchanged behaviors
being recorded as changed. Therefore, it is best to
invite a second observer to observe and record the
target behavior. The data from the two observers can
be compared to determine the interobserver reli-
ability, which is defined as “a measure of the degree
of agreement in data tallies made by two or more
observers” (Chance, 1998, p. 58).
Implement Behavioral Intervention
The third step in the behavior change process involves
identifying an effective intervention for changing the
184 Adapted Aquatics Programming
target behavior. Intervention data involve information
on the effects of the intervention that is collected
during the implementation phase. By comparing the
baseline data with the intervention data, the adapted
aquatics instructor can determine the changes that
have occurred as a result of the intervention. Remem-
ber, in ABA you link the target behavior to actions
occurring before the behavior (antecedents) and
to consequences that will occur after the behavior.
The intervention consists of changing the functional
relations between a behavior and its antecedents and
consequences (Chance, 1998; Lavay et al., 2006). In
the previous example with John, the adapted aquat-
ics instructor facilitated the participant’s entrance to
the pool via the ladder by eliminating the negative
reinforcers (antecedents) of other participants lin-
gering around the ladder. To develop, maintain, or
increase desired behaviors, you may select from a
variety of methods including positive reinforcement,
contingency contracts, modeling, shaping, and token
economies. For further information on these and
additional techniques of managing behavior, review
the references cited in this chapter and listed in the
reference section at the end of this textbook (Chance,
1998; Cooper et al., 1987; Lavay et al., 2006; Loovis,
2005; Seaman et al., 2003; Sherrill, 2004).
Evaluate Behavioral Intervention
The purpose of ABA is to solve a behavior problem,
usually by increasing or decreasing the rate of some
behavior. Once the new behavior has been estab-
lished, the adapted aquatics instructor may question
whether the observed changes resulted from the
intervention or from some unknown variable (Lavay
et al., 2006). Graphing is a simple and thorough
avenue for evaluation. Graphs clearly display data
and the behavioral change or lack of behavioral
change that occurs during the intervention. For
additional information on graphing procedures, refer
to Cooper, Heron, and Heward’s (1987) Applied
Behavior Analysis.
Data-Based Gymnasium Program
In the Data-Based Gymnasium (DBG) Program, you
identify a behavior to be changed, count its rate of
occurrence, and devise a systematic plan of action.
Then you put rewards, reinforcement schedules, and,
if necessary, punishments into effect. A behavior
modification program may be as strict as providing
one positive, tangible reinforcement (food or token)
combined with social praise for each on-task behav-
ior, or it may be a more lenient plan involving a cer-
tificate at the end of a 4-week session. To be the most
effective, the program requires the same consistent
treatment in other areas of the swimmer’s life.
DBG Behavior
Correction Procedure
The following information, taken from Physical
Education for the Severely Handicapped: A
Systematic Approach to a Data-Based Gym-
nasium (Dunn, Morehouse, & Fredericks, 1986),
is one model of behavior management and
instruction that you can apply directly to the
physical activity setting. This model, entitled
the DBG Program, can help you understand
the kind of consistency needed when working
with a person who has a brain injury, intellec-
tual disability, or behavior disorder.
Example Correction Procedure
of the DBG Program
❚ Give a verbal cue such as, “Jim, kick your
legs.” If participant responds properly, give
strong positive reinforcement and move
on. If the participant gives an improper or
no response, give a mild negative state-
ment such as, “No, Jim.” Then say, “Watch
me,” and go to the next step.
❚ Model the desired behavior (give a visual
cue), and then repeat the verbal cue. If
the participant responds properly, give
mild positive reinforcement and move on.
If the participant gives an improper or no
response, give a mild negative statement
such as, “No, Jane.” Then say, “Let me
help you,” and go to the next step.
❚ Give a verbal cue and physical assistance.
Give mild positive reinforcement if the
participant is cooperative. If the person is
displaying poor behavior, deal with that
before correcting the motor skill.
Rules for Cues
❚ Don’t repeat a cue unless the person
doesn’t hear or see it.
❚ Give the person time to process the cue
before moving on.
❚ Don’t change the wording of a cue.
Rules for Applying Consequences
❚ Each time you give a cue and the
person makes a response (or makes no
response), immediately (within 2 sec-
onds) let him know if the response was
correct or incorrect.
❚ Use any form of communication (e.g.,
signing, speaking, body language) to
reinforce the behavior.
❚ If you use primary, or tangible, reinforcers,
always pair them with verbal praise.

Aquatics personnel who are untrained in behavior
modification may not feel prepared to participate in
a treatment program. A few questions to consider
before implementing a specific behavior modifica-
tion program include the following: What behavior
will you target? What are the antecedent (preceding)
behaviors? What consequence, in terms of reinforce-
ment or punishment, will you provide following the
behavior? Remember, the key to behavior modifica-
tion is consistency: The participant must learn that
the consequences of certain behaviors will always
be the same.
Informal Behavior Modification
It may not always be possible to implement a formal
behavior modification program when participants
exhibit inappropriate behaviors during an aquatics
program. You can, however, intervene in simple and
practical ways to encourage more appropriate behav-
iors. In short, you can ignore, redirect, reinforce, and,
when absolutely necessary, remove inappropriate
behavior. Understanding these interventions is much
easier than internalizing the attitudes and skills that
you need to implement them. So let’s look at each
tool more closely.
Ignoring Inappropriate Behavior
A great deal of patience and compassion is required
to ignore behaviors that interrupt the continuity of
an aquatics program. But, unfortunately, the alterna-
tive is usually to engage in a confrontation, which
only aggravates a situation. While it is true that you
cannot ignore unsafe behaviors, whenever possible,
focus on appropriate or positive behaviors rather than
inappropriate or negative behaviors.
Redirecting Inappropriate Behavior
Redirecting involves providing an individual with
an alternative to the inappropriate behavior. For
example, during a swimming lesson a child might
shout and splash with another child in an effort to
gain attention. You could intervene by engaging both
children in a pleasant conversation while having them
hang onto a flotation device and practice kicking
across the pool. Explain or demonstrate alternative
behaviors that will meet the needs of the participant
as well as positively reinforce appropriate behavior.
Changing to another activity is another good way to
redirect behavior. Sometimes, however, nothing short
of direct one-on-one instruction and supervision may
be effective in redirecting a child.
Positively Reinforcing Appropriate Behavior
When the participant exhibits an appropriate behavior
after being redirected, offer positive reinforcement.
Instructional Strategies 185
Use words, body language, and participation in
desired activities. In the preceding example, you could
say to the children, “You did a great job kicking across
the pool and swimming with the rest of the group.
Thanks for helping everyone have a good time by
not splashing them.” Note that the comment praises
a specific action, as opposed to comments such as,
“Good job!” When stated with a sincere rather than
sarcastic tone, such a comment helps the participant
focus on appropriate behaviors and their effects. Make
other personnel aware of any specific behaviors that
you are trying to reinforce with particular participants.
Maintain the reinforcement until the participant has
internalized the new behavior. Keep in mind that only
continuity and consistency maintain a behavior.
Removing a Participant
Behavior disorders, such as hyperactivity, impulsivity,
aggression, and withdrawal, can become safety issues
if you do not manage the related behaviors properly.
Sometimes a participant may exhibit a behavior that
is so extreme that removal, or time-out, becomes
necessary. Removal becomes necessary for the safety
of anyone in the program, including the participant
being removed, other participants, and instructional
personnel. You might also remove a participant who
becomes so fearful and withdrawn that temporary
removal is the only way to calm her. Before removing
a participant, however, determine if other options are
possible, such as providing one-on-one supervision
and instruction.
Structuring the Learning Environment
Learning environments can be structured so that
individuals with behavior disorders can safely focus
on the tasks at hand and become more successful
in swimming activities and activities of daily living
(ADL) skills. The following suggestions (Lepore, 1991)
offer tips for managing various behaviors. For more
information on managing specific behaviors, see the
teaching tips under related disorders in chapter 9.
Suggestions for Assisting People With Short
Attention Spans, Restlessness, and Disorientation
• Keep structured swim lessons short (no longer
than 30 minutes).
• Limit crowds, noise, and other distractions to
help decrease time spent off task. Keep in mind
that some participants can only function in set-
tings with minimal distractions.
• If possible, maintain a one-on-one instructor-
to-participant ratio, but if necessary you should
be able to manage 2 or 3 swimmers who are
not agitated and do not have severe behavior
disorders.
186 Adapted Aquatics Programming
• Try having a participant swim toward the wall
or face away from the rest of the pool in order
to improve attention during a lesson.
• Arrange to have lap counters to help the par-
ticipant keep track of laps.
• Use kitchen timers to help a person remember
when to leave or how much time he has spent
on a task.
Suggestions for Developing the Ability to
Self-Monitor
• Teach people how to take their own pulse.
• Use journals, worksheets, or logs so that indi-
viduals can see what they have accomplished
session to session.
• Ask questions so that participants can recall and
verbalize their activities and progress.
• Give verbal feedback continuously; this feed-
back acts as an external monitor, validating the
individual’s internal experience.
Suggestions for Working With People Who Are
Easily Frustrated, Quickly Irritated, or Impatient
With Themselves and Others
• Use logical progressions of skills during each
lesson.
• Build success into every lesson.
• Task-analyze each motor skill, because present-
ing one small part of the skill instead of the
whole skill at once will increase success.
• Offer sincere positive reinforcement for each
accomplishment.
• Arrange to send the lesson plan to the par-
ticipant or caregiver a day before swimming
class, as doing so can alleviate problems with
participants who don’t deal with changes very
well. The extra day helps them prepare psycho-
logically for a new and often frightening skill.
This plan is not for everyone, however! Some
individuals might worry about new skills and
then not want to come to the session.
• Set the tone for sessions that are free of misun-
derstandings and therefore free of frustrations
by consistently applying rules, following pro-
cedures, presenting tasks, and reinforcing or
punishing behavior.
• Incorporate 5-minute free swims into your
sessions as a fun and motivating way to vary
structure.
• Keep structured lessons 5 to 30 minutes long,
according to the swimmer’s attention span.
• Talk with the swimmer’s psychologist for a
behavior modification program.
• Talk to the participant while she is exhibiting
poor behavior and explain how the behavior is
not appropriate.
• Frequently change activities and provide con-
tained choices to help decrease restlessness and
increase motivation.
Summary
Developing instructional strategies for teaching
aquatic skills requires instructors to examine the
process of learning and the factors affecting learn-
ing. Indeed, no aquatics program that serves the
diverse needs of participants with disabilities can be
successful without attention to the individual needs
of each participant. There is no single approach to
aquatics instruction. You must consider anatomical,
physiological, and medicinal parameters that affect
the learning process. When you are planning your
instruction, you must consider psychological factors
including motivation, trust, cognitive readiness, social
ability, learning style, and behavioral analysis. When
you accommodate the psychological functioning of
your participants, you can establish realistic goals
and set up an effective and pleasurable learning
environment.
When bridging the gap between the planning
and the implementation of programs and classes,
recognize that environmental, emotional, physi-
ological, and psychological elements may have a
greater effect on individuals with disabilities due to
their different and more pronounced needs. Identify
how each element affects the participant so that you
can plan, deliver, and adapt appropriate instructional
strategies in a competent, sensitive, and effective
manner. Remember, individuals who face cognitive,
emotional, and physical challenges in the aquatic
realm need you to carefully plan adapted strategies
and styles during each lesson. The most important
contribution the instructor can provide is appropriate
cues and immediate corrective feedback. However,
the suggestions and general strategies for adapting
instructional design and delivery discussed in this
chapter are not educational recipes with stringent
formulas for success; they are merely offered as a
resource to help you modify existing strategies as
needed. Remember, it is pedagogically sound to
implement stroke adaptations to allow a participant
to develop individual functional lifelong swimming
skills.
 Instructional Strategies 187

Chapter 8
Review 1. List and explain the three stages of learning new motor skills.
2. What are physiological factors that affect the ability to learn aquatic
skills?
3. How can medications affect an individual’s behavior?
4. How can you accommodate various learning styles in an aquatic setting?
5. Explain how psychological conditions can inhibit the acquisition of
aquatic skills.
6. List 11 teaching styles described in this chapter.
7. What are the basic elements of effective instruction that should be pres-
ent in order to enhance learning opportunities?
8. Define knowledge of results (KR) and knowledge of performance (KP).
9. Explain how you can help a participant improve performance through KR
and KP.
10. Define active learning time (ALT).
11. What is applied behavior analysis (ABA)?
12. What are the four sequential steps of the behavioral assessment?
13. Differentiate between antecedents and consequences.
14. Discuss important considerations when adapting swim strokes.
15. Discuss specific stroke adaptations for individuals with brain insults, spinal
cord injuries, and amputations.
This page intentionally left blank.
 9
Specific Needs of
Adapted Aquatics
Participants

D ylan is a 15-year-old experienced swimmer with Down syndrome. Last year,

during his first semester in high school, he attended a meeting for students
interested in trying out for the swim team. The coach was hesitant to let Dylan try
out because she had heard that people with Down syndrome have something
wrong with their neck that prohibits diving. In the physical education office the
next day, the coach saw the itinerant APE teacher and asked for advice. The
APE teacher explained the issue of atlantoaxial instability and assured the coach
that Dylan, who she knew from his participation in APE, had a negative X-ray for
atlantoaxial instability and could dive. The coach was pleased to discover that
knowledge about disability differences and the unique attributes of learners was
all that was needed to begin breaking down the stereotype of what she had
heard and what was true in relation to individuals with disabilities.

189
190 Adapted Aquatics Programming
I n this chapter, we begin by defining several common
disabilities, and then we look at common partici-
pant attributes that pose obstacles to achieving swim
skills or creating safety in the aquatic environment.
We look at what type of disability these attributes are
commonly seen in and how these attributes affect
the aquatic experience. We also offer teaching tips,
safety factors, and goals that you should target when
working with people with the different attributes.
Table 9.1 presents a chart that matches disabilities
with attributes. If you want to find certain attributes
that are common in a specific disability, locate the
disability in the left column of table 9.1. Move across
the corresponding row, stopping at all the boxes
in that row that are marked. The marks imply that
people with this disability have a greater chance of
possessing this characteristic than people without
disabilities have. Look up that characteristic in the
chapter headings and read more about it. Learning
about the characteristic will assist you in adapting
your lesson plans and teaching strategies during
aquatics instruction and recreation, if the participant
with the disability has that characteristic.
You should not assume that the characteristics
marked in table 9.1 will be manifested in each person
who has a certain disability. Instead, discuss the chal-
lenges related to the disability with each individual
and his caregivers, assess the individual on land and
water, and then make a list of attributes to review in
this chapter.
We cannot emphasize enough that in order to
meet the needs of a variety of individuals, you must
know the unique attributes of each learner in order to
provide safe, effective, and relevant aquatic opportu-
nities. You do need information pertaining to common
disabilities and their implications for the aquatic set-
ting. Refrain, however, from looking at a person as a
disability with given characteristics; instead, ascertain
what the person can do. Labeling the individual with
a certain diagnosis is counterproductive: It has little
to do with what that particular individual will be able
to accomplish in and around the pool.
Labeling individuals with disabilities emphasizes
the diagnosis of a person’s condition or disability,
resulting in statements of what an individual has
rather than what he does, such as “Linda has CP,”
“John is intellectually disabled,” or “Tisha is learning
disabled.” The social complexities of focusing on an
individual’s primary disability or diagnostic category
can cause negative attitudes and low expectations. It
leads to professionals not seeing the individual but
instead programming and planning for the disabil-
ity. The label of intellectual disability, for example,
might burden a person her entire life, lowering her
self-esteem, separating her from others, and possibly
reducing her social opportunities.
Yet, a list of common disability characteristics
may help with planning for possibilities in certain
situations and may provide necessary precautions.
For example, as in the chapter-opening scenario, an
instructor’s ignorance about the atlantoaxial instabil-
ity found in some participants with Down syndrome
can be potentially limiting, neglectful, or dangerous
to the individual. Moreover, categorical methods pro-
vide opportunities for special services, individualized
programs, and finances for therapeutic equipment.
When using categorical methods, you and the trans-
disciplinary team must clearly understand the issues
involved in labeling individuals with disabilities. Such
identification should be for the purpose of provid-
ing access to services, not for categorically placing
certain characteristics on people or subjecting them
to segregated programs. With this in mind, we have
structured this chapter as noncategorically as pos-
sible. To help you find what you need to know quickly,
we have arranged the attributes in alphabetical order,
and the description for each attribute includes sec-
tions on common related disabilities, teaching tips,
safety issues, and goals to target.
Chapter Objectives
From this chapter, you will learn the
following:
* There are numerous medical, health,
and safety issues that surround various
disabilities.
* There are general teaching tips and
goals to target for a variety of unique
disability attributes.
* There are characteristics and attributes
that are common among several dis-
abilities.
Definitions of Common
Disabilities in Adapted
Aquatics
acquired immune deficiency syndrome (AIDS)—The
outcome of HIV infection, causing high susceptibility
to all kinds of bacterial and viral infections due to an
inadequate immune system.
 Table 9.1

Disability Reference Sheet

Receptive or expressive language disorder

Memory and understanding difficulty

Temperature regulation disorder

Contracture or ROM limitations
Auditory perception disorder

Kinesthetic system disorder

Visual perception disorder

Vestibular system disorder
Primitive reflex retention
Cardiovascular disorder

Oral motor dysfunction

Atrophy (see page 214)

Head control difficulty

Tactile system disorder

Atlantoaxial instability

Interaction difficulty

Respiratory disorder
Circulatory disorder

Paralysis or paresis

Visual impairment
High muscle tone

Multisensory loss

Seizure disorders
Joint dysfunction
Attention deficit

Posture disorder
Hyperactivity
Brittle bones

Hearing loss
ADD 3 3

ADHD 3 3 3

Alzheimer’s disease 3 3 3 3 3 3 3 3

Amputation 3 3 3 3 3

Arthritis 3 3 3

Asperger’s 3 3 3 3 3 3 3 3 3

Autism 3 3 3 3 3 3 3 3 3 3 3

Behavior disorder 3

Blindness 3

Cerebral palsy 3 3 3 3 3 3 3 3 3 3 3

Deaf/blindness 3 3 3

Deafness 3

Diabetes 3

Down syndrome 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Fetal alcohol syndrome 3 3 3 3 3 3 3 3 3

Fragile X syndrome 3 3 3 3 3 3 3 3 3 3 3 3

Hemophilia 3 3 3
Intellectual disability
3 3 3 3 3 3 3 3 3
  (MR)
Juvenile rheumatoid
3 3 3
  arthritis
Kyphosis 3 3

Learning disability 3 3 3 3 3 3 3 3 3

Legal blindness 3

Lordosis 3 3

Multiple sclerosis 3 3 3 3 3 3 3 3 3 3

Muscular dystrophy 3 3 3 3 3

Osteogenesis imperfecta 3 3 3 3 3 3

Paraplegia 3 3 3 3 3 3

Prenatal drug exposure 3 3 3 3 3 3 3

Quadriplegia 3 3 3 3 3 3 3 3 3

Scoliosis 3 3
Spina bifida:
3 3 3 3 3
  myelomeningocele
Spinal cord injury 3 3 3 3 3 3 3 3

Stroke 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

Traumatic brain injury 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

191
192 Adapted Aquatics Programming
Alzheimer’s disease—A disability of unknown origin pri-
marily affecting the older population; it may involve a
variety of symptoms ranging from mild memory loss to
profound disorientation and from passivity to aggression.
Symptoms may also include physical disabilities.
amputated limb—A limb (partial or full) that is missing
from the body, either from birth or from amputation
occurring later in life.
arthritis—Inflammation of the joints and concurrent
damage to the various articulating surfaces within the
joints.
arthrogryposis—A nonprogressive disorder that affects
many of the joints, making them weak, stiff, and swol-
len. Joint angles may be atypical; intelligence is usually
normal. This disorder is also known as multiple congeni-
tal contractures.
asthma—A respiratory condition in which either exercise or
allergens induce bronchial inflammation and increased
mucus production, leading to wheezing, coughing,
difficulty exhaling, shallow breathing, feelings of chest
constriction, and difficulty regulating breathing.
ataxia—A descriptive term meaning poor balance and
general lack of coordination; ataxia is also a type of
cerebral palsy.
attention deficit disorder (ADD)—A difficulty focusing
on tasks, distractibility, or a difficulty attending to
directions.
attention deficit hyperactivity disorder (ADHD)—ADD
combined with hyperactivity, which leads to fidgeting,
impulsivity, excessive movement, impatience, and low
tolerance for frustration.
autism—A pervasive developmental disability, typically
revealed before the age of 30 months, in which interac-
tion with people is impaired, activity level is significantly
above or below average, and eye contact is minimized.
People with this disorder may engage in echolalia,
exhibit no fear of real dangers, engage in odd play, or
display inappropriate attachments to objects.
behavior disorder—A behavior that is exhibited over a
long time and to a marked degree, adversely affecting
learning. Severe behavior disorders include noncom-
pliant, self-stimulatory, self-abusive, and aggressive
behavior. People with behavior disorders may also be
described as being emotionally disturbed or socially
maladjusted.
blindness—A lack of sight that is severe enough that a
person cannot see shapes, shadows, or light. Vari-
ous terms, such as total, low-partial, and high-partial
blindness, describe visual impairment of one degree
or another.
cancer—An abnormal reproduction of atypical cells that
leads to tumors. Chemotherapy and radiation therapy
treatments are common.
cerebral palsy—A general term applied to nonprogressive,
neuromuscular disorders affecting normal, orderly motor
development and voluntary muscle control. These dis-
orders are caused by a brain lesion before, during, or
shortly after birth. Common types are ataxia, athetosis,
spastic, flaccid, and tremor.
Deafness—Severe hearing loss in which a person cannot
understand speech even with a hearing aid; also a
cultural minority that uses sign language as a commu-
nication medium.
diabetes—A metabolic disorder in which the body does
not produce or underproduces insulin, preventing body
cells from using sugars for energy.
Down syndrome—A congenital disorder in which there
is an extra chromosome on the 21st pair. Common
characteristics are short stature, cognitive impairment,
speech and language disorders, congenital heart defects,
visual and hearing impairments, flat feet, lax ligaments,
low muscle tone, joint instability, and, sometimes,
atlantoaxial instability.
fetal alcohol syndrome—A condition in which a fetus is
prenatally exposed to alcohol through the mother’s
alcohol abuse. Symptoms include small size for age,
abnormal muscle tone, developmental delays, and
abnormal alertness, attention, and learning. It is a lead-
ing cause of intellectual disability.
hard of hearing—A classification of hearing loss in which
a person can understand linguistic information by using
amplifiers and hearing aids.
heart defects—Malformations of the heart, which can be
congenital or acquired and can hamper an individual’s
ability to become or remain fit.
hemophilia—A blood disorder in which the protein needed
to clot blood is lacking, leading to internal or external
bleeding or both. Internal bleeding into joints (hem-
arthrosis) can cause joint dysfunction.
hydrocephalus—An accumulation of cerebrospinal fluid on
the brain, causing enlargement of the head and pressure
on the brain. Excessive brain pressure causes cognitive
impairments. Hydrocephalus is often seen in individuals
with myelomeningocele spina bifida.
juvenile rheumatoid arthritis (JRA, Still’s disease)—Inflam-
mation of many joints throughout the body that appears
in childhood. Often symptoms decrease 10 years after
onset, but some children may have chronic joint damage
and severe disability into adulthood.
kyphosis—A posture problem in which the muscles of
the upper back are weak, causing poor extension of
the upper back and leading to a humpbacked appear-
ance.
learning disability—A dysfunction in one or more of the
psychological processes involving written or spoken lan-
guage that is not caused by deafness, blindness, mental
retardation, or environmental disadvantage.
legal blindness—A loss of vision that equals a visual acuity
of 20/200 or worse (with correction) in the better eye or
a field of vision of 20° or less.

les autres—A term meaning the others that includes dis-
abilities other than spinal cord injury, cerebral palsy,
closed head injury, stroke, amputation, visual impair-
ment, mental impairment, or hearing disability.
lordosis—A postural problem (swayback) in which
the lumbar area is hyperextended because of weak
abdominal muscles or tight hip flexors and low-back
muscles.
mental retardation—Substantial limitations in daily func-
tioning due to intellectual functioning that is signifi-
cantly lower than average, with limitations in two or
more of the following: communication, self-care, home
living, social skills, self-direction, health and safety,
functional academics, and abilities to pursue leisure,
use the community, and perform work (American Asso-
ciation on Mental Retardation [AAMR], 1992). Mental
retardation manifests itself during childhood and is
currently referred to as intellectual disability.
multiple disabilities—The existence of more than one
impairment, such as cerebral palsy combined with blind-
ness or spina bifida combined with mental retardation,
which causes profound problems in learning (Federal
Register, 2006).
multiple sclerosis—A progressive disorder of the nervous
system characterized by degeneration of the myelin
sheath surrounding the nerves. Onset usually occurs in
young or middle-aged adults, and its cause is unknown.
This disorder affects more women than men.
muscular dystrophy—The name for a group of degenerative
disorders affecting muscle tissue and causing atrophy,
weakness, and severe physical disability.
myelomeningocele—A severe type of spina bifida in which
the spinal cord and its covering are herniated through
the posterior part of the vertebrae, causing paralysis in
the body parts below the herniated site; the hernia is
most commonly located in the lumbosacral (low-back)
region, with accompanying paraplegia.
obesity—A condition characterized by the excessive
accumulation and storage of fat in the body; females
weighing 30% to 35% and males weighing 20% to
25% more than the expected weight for their height
and body frame size are classified as obese. A person
who weighs 50% more than the expected weight for his
height and frame size is classified as superobese (Jansma
& French, 1994).
osteogenesis imperfecta—A condition of brittle bones
with several classifications, in which individuals may
or may not have skeletal deformities, may or may not
be ambulatory, and may or may not have normal life
expectancy (Blauvelt & Nelson, 1994).
paraplegia—Loss of voluntary muscle control in the lower
extremities.
poliomyelitis—An acute phase of inflammation of the
gray matter of the spinal cord, causing loss of voluntary
muscle control and thus long-term disability.
Specific Needs of Adapted Aquatics Participants 193
postpolio syndrome—A variety of characteristics commonly
seen in individuals older than 50 years who have had
polio since childhood. Symptoms include joint dysfunc-
tion, paralysis or paresis, and brittle bones.
Prader-Willi syndrome—A genetic condition marked by
mental retardation, low muscle tone, short stature, and
obesity (Wiedemann, Kunze, Grosse, & Dibbern, 1992).
quadriplegia—Loss of voluntary muscle control in all ex-
tremities.
scoliosis—A posture disorder resulting in a C- or S-lateral
(side-to-side) curve in the spine.
seizure disorder—Any of a number of convulsive and
nonconvulsive disorders frequently associated with
epilepsy. Generalized (grand mal) seizures involve
involuntary tensing (tonic phase) and then jerking
(clonic phase) of the muscles of the whole body.
Other types of seizures are partial, unilateral, and un-
classified.
spina bifida—A congenital neural tube defect, which can
be mild (SB occulta), with no disability, severe (SB
myelomeningocele), or not as severe (SB meningocele).
See myelomeningocele for more information.
stroke (cerebrovascular accident)—A lack of oxygen to a
part of the brain due to blood vessel occlusion, hard-
ening of the arteries, embolism, tumor, or aneurysm
rupture. A stroke can cause hemiplegia, speech and
language disorders, and permanent disabilities.
traumatic brain injury—An injury to the brain due to a
closed or penetrating (open) head injury that causes
multiple disabilities.
traumatic spinal cord injury—Trauma occurring to the
vertebrae, the spinal cord, or both that results in a loss
of sensation and voluntary motor control. The injury
can be mild (a broken vertebra), which may result in
temporary paralysis, or severe (severed spinal cord),
which results in permanent paralysis from about the site
of the injury downward.
Commonly Seen Attributes of
Learners in Adapted Aquatics
The following section in this chapter includes infor-
mation about a variety of characteristics that might be
found in students with disabilities who are participat-
ing in an adapted aquatics program. Once the student
has been interviewed by the staff and a clear picture
is drawn of her strengths and needs, including her
medical, behavioral, safety, learning, and motor skill
strengths and needs, you as the aquatics instructor
should look to this section to read about the related
issues that may occur in your swim class.
194 Adapted Aquatics Programming
Atlantoaxial Instability
Common Related Conditions
This attribute is commonly seen in individuals with
❚ Down syndrome or
❚ Morquio syndrome.
Atlantoaxial instability syndrome (AAIS), also called
atlantoaxial dislocation syndrome (ADS), is a neck
instability resulting from pathology within the first
(atlanto) and second (axial) cervical vertebrae. This
instability can potentially result in a dislocation of
the atlas vertebrae that causes spinal cord injury or
death. This orthopedic problem may occur in 17%
of individuals with Down syndrome (see figure 9.1)
and is said to occur due to lax ligaments and muscles
surrounding the joints (Sherrill, 2004). Although 17%
is not a majority, for safety reasons, you should treat
all individuals with Down syndrome as though they
have atlantoaxial instability unless there is a specific
medical script to the contrary.
Teaching Tips
• Seek information from a physician as to the
status of swimmers with Down syndrome.
• Consult with medical personnel on specific
movements to stress or avoid.
Figure 9.1  Atlantoaxial instability syndrome may be an attribute of individuals with Down syndrome.
Safety Issues
• An X-ray positive for AAIS leads a physician
to write contraindications to (in other words,
prohibit) forcefully bending the neck forward
(flexion) and backward (hyperextension).
• Participants with AAIS should not participate
in diving, the butterfly stroke, or warm-up
exercises that place pressure on the neck and
head.
Goals to Target
Plan activities that avoid forcefully bending the neck
forward and backward and attempt to improve swim
skills that do not put pressure on the head or neck;
emphasize participation in safe aquatic activities.
Attention Deficit
Common Related Conditions
This attribute is commonly seen in individuals with
❚ ADHD combined type,
❚ ADHD predominantly inattentive type,
❚ ADHD predominantly hyperactive-impulsive
type,
❚ learning disabilities,
❚ intellectual disability,

❚ Asperger’s syndrome,
❚ autism,
❚ fragile X syndrome,
❚ Down syndrome,
❚ traumatic brain injury,
❚ history of stroke, or
❚ prenatal exposure to drugs.
The ability to initially attend to a task and then main-
tain attention to complete it greatly improves the
chances of learning the task. Individuals who experi-
ence chronic and intense difficulties with addressing
and sustaining attention on demand, persisting in
tasks that are developmentally appropriate, following
rules, and concentrating tend to have trouble improv-
ing their skills. They may perform a task once or twice
and then be ready to move on. Their lack of attention
and persistence often leads to immature skills.
Teaching Tips
• Say the participant’s name to gain attention
before providing feedback or giving directions.
• Provide only one aspect of feedback at a time
and make it frequent and specific.
• Stay near the participant in order to ascertain
changes in attention and on-task behavior.
• Provide advance notice of upcoming changes
to the routine or a switch from one task to
another, as transitions from activity to activity
may be difficult.
• Plan activities that deemphasize competition.
• Plan for additional emotional support during
times of stress and fatigue.
• Encourage self-monitoring of activities, because
self-control is an important goal.
• Assign one task to be completed at a time.
• Provide learning support such as cue cards,
a paraeducator, or a peer tutor for tasks that
require a longer time to complete or are very
challenging.
• Maintain eye contact when providing verbal
directions.
• Use positive reinforcement to encourage cor-
rect behavior.
• Use a calm, firm voice during discipline.
• Use preestablished cue words or hand motions
to decrease unwanted behavior.
• Follow through with preestablished conse-
quences that are as natural to the setting as
possible.
Specific Needs of Adapted Aquatics Participants 195
• Structure swim lessons to be no more than 30
minutes long.
• Schedule pool times during which crowds,
noise, and other distractions are at a minimum
to help decrease time spent off the task.
• Use a one-on-one ratio when appropriate and
available.
• Arrange for the participant to swim toward a
wall or face away from the rest of the pool
while practicing.
• Supply lap counters to help the participant keep
track of laps.
• Provide kitchen timers to help the participant
visualize how much time he has spent on a
task.
Safety Issues
• Use additional lifeguard coverage to enhance
the supervision of impulsive participants.
• Repeat rule explanations often and ask the
participant to repeat the rules when distractions
are present.
• Keep the pool decks dry and free of equipment,
as hyperactivity may accompany attention defi-
cit in some students.
Goals to Target
Strive to increase the participant’s ability to follow
multitask directions, time spent on task, and qual-
ity of aquatic skills; work to decrease impulsive
behaviors.
Auditory Perception Disorder
Common Related Conditions
This attribute is commonly seen in individuals with
❚ a variety of learning disabilities,
❚ autism,
❚ Asperger’s syndrome,
❚ fragile X syndrome,
❚ traumatic brain injury, or
❚ history of stroke.
An individual’s ability to process the sound that enters
the ears may be hindered by damage to the structural
mechanisms for auditory input, as occurs in people
who are deaf or hard of hearing, or by the inability of
the brain to translate the sound into meaningful infor-
mation, as occurs in people with auditory perception
196 Adapted Aquatics Programming

problems. Deafness and hard of hearing differ from

auditory perceptual difficulties. Deafness and hard
of hearing are problems with auditory acuity, while
auditory perception difficulties are problems with
picking out important auditory information from a
complex sound background.
If a participant has trouble with hearing due to
auditory perception problems, find out her level of
sound identification and discrimination in addition to
her auditory memory and sequence skills. Acoustics
in the pool area do not provide a good background
for auditory discrimination, and often participants
with auditory perception problems cannot focus on
the primary components of a message. Another area
of difficulty for these participants is that they may not
be able to move rhythmically to music or to a beat.
Teaching Tips
• Use written or pictorial cue cards in conjunction
with verbal directions.
• Repeat verbal directions to the participant,
using as few words as possible.
• Use games like Marco Polo that focus on sound
identification to improve practice in this area.
• Initially bring attention to and name environ-
mental sounds so that swimmers know what
background noise they are dealing with.
• Use voice inflection to focus attention on
important points.
• If age appropriate, use songs or rhythms to
imitate the rhythmic breathing used in the front
crawl, such as “Row, row, row (breathe) your
boat, gently down the stream (breathe). . . .”
Put the emphasis on the breathing word as
appropriate.
• Provide a steady tempo, such as a drumbeat,
for students who have difficulty with rhythmic
patterns due to lack of auditory rhythmic ability.
Have students stand in place to perform arm
movements in correct rhythm, using a bigger bang
on the drum or kickboard for the breath action.
Safety Issues
Provide extra assistance when giving verbal explana-
tions to be sure that the participant knows the rules,
and have participants repeat what was said or answer
questions about the rules or explanations.
Autonomic Dysreflexia or
Hyperreflexia
Common Related Conditions
This attribute is commonly seen in individuals with
❚ spinal cord injury at T6 or above.
Autonomic dysreflexia or hyperreflexia may occur in
individuals with spinal cord injury above T6 and is
a medical emergency. Signs include pounding head-
aches, goose bumps, sweating, or vomiting that may
result from overextension of the bladder or colon,
which in turn may be caused by a blocked catheter,
a disturbance of bowel and urine schedules, or pur-
posely keeping the bladder full. Other infections and
irritations such as pressure sores and kidney stones
may also cause this phenomenon.
Teaching Tips
• Remind the participant to empty waste collec-
tion bags or pouches before swimming.
• Be sensitive about privacy and personal space
due to waste collection equipment.
• Occasionally assist the participant in checking
catheter tubing for kinks.
• Remind the participant of the need to empty
the bladder or collection equipment before and
after swimming.
Safety Issues
• Summon appropriate medical personnel imme-
diately when you see signs such as pound-
ing headaches, goose bumps, vomiting, and
extreme sweating, as these indicate a medical
emergency.
• Provide first aid by moving the head and upper
body to a sitting position, emptying the bladder
or colon or both, taking blood pressure, and
activating the EMS.
Goals to Target
Help the participant become more aware of healthy
habits, improve fitness, and increase or maintain
physical activity for improved bladder drainage.

Goals to Target
Strive to provide activities that improve auditory
Balance Disorder
memory, sequencing, stroke rhythm, and auditory
discrimination. See Vestibular System Disorder on page 222.

Brittle Bones
Common Related Conditions
This attribute is commonly seen in individuals with
❚ osteogenesis imperfecta (in various catego-
ries),
❚ osteoporosis,
❚ spina bifida,
❚ traumatic spinal cord injury, or
❚ any progressive neurological or orthopedic
condition that compromises weight bearing.
Imperfect bone growth is typically a congenital
impairment that is inherited as a deficiency in the
ability to grow dense bones, but it can also be
caused later in life by trauma, disease, lack of weight-
bearing activity, or mineral deficiency. Bones that are
structurally weak will not grow properly and may be
brittle. Brittle bones may be subject to repetitive frac-
tures that may result from walking, bumping, jarring,
transferring into and out of the pool, and high-impact
or stationary weight bearing.
Individuals with congenital osteogenesis imper-
fecta (OI) may have excessively mobile joints
(hypermobility) as well as thin (atrophic), fragile skin.
Most people with congenital OI use wheelchairs for
mobility. Bone fractures may decrease after age 15,
but chest deformity and posture problems may lead
to decreased vital lung capacity and permanent dis-
ability. Individuals with congenital or late-developing
bone growth deficiencies most often have posture
deviations such as kyphosis, scoliosis, and bowed legs
(see Posture Disorder on page 216). Swimming is an
especially appropriate activity because an individual
can participate with a minimal risk of injury.
Teaching Tips
• Adapt entry and exit skills to accommodate
individuals who have mobility assistive devices,
including wheelchairs.
• Use water tables or tot docks to accommodate
individuals with congenital OI, who typically
have short stature.
• Use soft equipment such as beach balls to limit
risk of contact injury.
• Treat individuals with OI in an age-appropriate
manner despite the fact that their small stature
tends to make them appear younger.
• Develop a sense of trust, as individuals with
brittle bones may be totally dependent on you
for safety.
Specific Needs of Adapted Aquatics Participants 197
• Adjust cardiorespiratory activities to accom-
modate decreased vital lung capacity due to
chest deformities.
• Adapt activities for people who have difficulties
with range of motion. Although people with
congenital OI may have hypermobile joints,
weak muscles may limit their functional ranges
of motion.
• Encourage underwater movement using isomet-
ric exercises, which tighten and relax muscles
without requiring resistance and without going
through range of motion.
• Use continuous rhythmical activities instead of
fast, ballistic, stop-and-go, or jerky movements.
Safety Issues
• Make injury prevention a priority, providing
protection as needed.
• Provide assistance during pool entry and exit
and during physical support in the pool.
• Distribute pressure over the trunk when pro-
viding support during transfers, applying little
pressure on the limbs.
• Avoid crowded areas in the pool in order to
avoid bumping into others.
• Obtain medical clearance for jarring or high-
impact activities such as hurdling on the diving
board and jumping or diving into the pool.
• Brainstorm with caregivers, participants, and
medical personnel to learn precautions that
you should take in transfers and pool entry
and exit.
• Avoid risky activities such as jumping, high-
impact activities, bumping, and contact with
others, equipment, walls, and floors.
• Avoid trunk and limb twisting.
• Report areas of redness, swelling, and heated
skin to participants and caregivers.
Goals to Target
Physical goals to target include improving body
awareness (through carefully designed movement
exploration), muscle strength, and functional range
of motion; improving or maintaining vital lung capac-
ity; increasing physical comfort level; and decreasing
posture deviation progression. Psychological goals
include improving the quality of life through fun,
normalized activities and increasing independence
through recreational activities. Focus on increas-
ing participant awareness of how to stay safe in the
aquatic environment.
198 Adapted Aquatics Programming
Cardiovascular Disorder
Common Related Conditions
This attribute is commonly seen in individuals with
❚ pulmonic or aortic stenosis,
❚ coarctation of the aorta,
❚ tetralogy of Fallot,
❚ transposition of the great vessels,
❚ rheumatic heart disease,
❚ ventricular or atrial septal defect,
❚ valvular defect,
❚ coronary artery disease,
❚ history of stroke,
❚ congestive heart disease,
❚ dysrhythmia,
❚ Down syndrome, or
❚ Williams syndrome.
Cardiovascular disorders can be congenital or
acquired, progressive or nonprogressive, temporary
or permanent, primary or secondary. Although not
visible, disorders of the heart and circulatory system
can be as limiting as, or more limiting than, neu-
romuscular or orthopedic disabilities, because the
cardiovascular system is responsible for transporting
oxygen and nutrients to the body. Examples of pri-
mary cardiovascular disorders are rheumatic heart
disease and valvular stenosis. Secondary disorders
include congenital heart defects accompanying
Down syndrome or peripheral vascular disease
caused by diabetes. Research the limitations of the
cardiovascular challenges that are evident in your
participants. There are many forms of cardiovascular
disease (CVD), including congenital heart disorders,
acquired inflammatory heart diseases, valvular disor-
ders, congestive heart disorders, degenerative heart
diseases, and vascular disorders (Surburg, 1995). In
general, cardiovascular disorders that limit function
result in decreased oxygenation of the blood, insuf-
ficient cardiac output, and abnormalities in trans-
porting the blood supply. Total physical performance
suffers because of low endurance. Fatigue, tingling
in the extremities, dizziness, and blurred vision may
be problems that force individuals to be sedentary
(Miller & Sullivan, 1982).
Teaching Tips
• Keep in mind that position influences the
cardiovascular demand of the physical activ-
ity: Activities performed in a horizontal or
recumbent position are the least strenuous,
activities performed in sitting positions are more
strenuous, and activities performed in standing
positions are the most strenuous.
• Provide aerobic activity at a level commensu-
rate with the physician’s direction.
• Monitor target heart rate zone with heart rate
monitors.
• Communicate frequently about exertion level.
Use the perceived exertion scale by Borg (1998)
to monitor the participant’s fatigue level.
• Have a physician designate the level of restric-
tion using an MET equivalent chart.
• Reduce intensity in hot, humid surroundings.
• Refer to the Physicians’ Desk Reference (Sifton,
2006) regarding medications and exercise.
• Incorporate frequent rests into aquatic ses-
sions.
• Encourage calorie-burning, low-intensity swim-
ming.
• Lower the intensity of swimming by proposing
an underwater recovery of the arms during
swim strokes.
• Lower the intensity of the exercise by not rais-
ing arms out of the water and above the head
during vertical exercises.
Safety Issues
• Be aware that water pressure affects the elastic-
ity of the lungs, causing difficulty in expansion
and contraction. Aquatics might be contra-
indicated for individuals with compromised
heart function or mitral valve obstruction due
to breathlessness resulting from water pressure
on the chest wall.
• Be aware that although warm water increases
circulation, water temperatures over 98 °F (36.7
°C) may be contraindicated for people with
heart problems.
• Monitor pulse rate (before, during, and after
exercise) and blood pressure (before and after
exercise) to make sure that swimmers comply
with physician-approved target heart rate
zones.
• Check with the physician for contraindicated
activities, such as isometric exercises (which
may possibly increase blood pressure).
• Move slowly when changing positions (e.g.,
when moving from lying on back to standing),
as the heart needs time to compensate for the
new position (Daniels & Davies, 1975).

Goals to Target
Programs for individuals with cardiovascular disor-
ders should focus on increasing aerobic endurance,
relaxation, and knowledge of physical strengths and
limitations. Individuals should strive to increase safe
participation in lifetime aquatic fitness activities.
Circulatory Disorder
Common Related Conditions
This attribute is commonly seen in individuals who
have
history of stroke,
❚
Safety Issues
❚ traumatic spinal injury,
❚ traumatic brain injury,
❚ diabetes,
❚ orthopedic injury,
❚ lead poisoning,
❚ amputation,
❚ peripheral vascular disease,
❚ hemophilia,
❚ sickle-cell disease, or
❚ advanced age.
Circulatory disorders involve pathology to the veins,
arteries, or blood traveling through the body. These
conditions may result from irregularly shaped cells,
hardening of the arteries, fat deposits forming plaque,
high blood pressure, inability of the blood vessels to
repair themselves (to clot), aneurysms, or insufficient
oxygen-carrying capacity. In general, insufficient
circulation can cause fatigue, poor aerobic capac-
ity, heart attack, stroke, and poor sensation in the
extremities.
Teaching Tips
• Be aware that although warm water increases
circulation, water temperatures over 98 °F (36.7
°C) may be contraindicated for people with
circulatory problems.
• Encourage individuals with poor muscle tone in
their lower bodies (where blood pools in legs
and feet) to kick or move their legs.
• Caution others against passively moving or
massaging participants’ legs, as doing so is con-
traindicated due to the possibility of dislodging
blood clots.
• Keep in mind that decreased blood flow to
the extremities causes feet and legs to bruise
easily.
Specific Needs of Adapted Aquatics Participants 199
• Use caution in walking, transferring, climbing
stairs, and performing swim strokes.
• Be aware that decreased blood flow to the
extremities may cause hands and feet to be
cold.
• Encourage participants to dry their hands and
feet well and to cover themselves in dry towels
when they finish swimming.
• Keep in mind that pain, aching, and cramp-
ing are also problems caused by inadequate
blood supply to the extremities. Encourage
participants to rest when these symptoms occur
(Sherrill, 1993a).
• Due to insufficient blood supply in the extremi-
ties, cuts and bruises may heal poorly, which
may lead to chronic skin ulcers and gangrene.
• If edema (swelling) occurs in the feet and ankles,
report it to the individual and his caregivers.
• In one type of circulatory disorder, uncontrolled
hypertension, strenuous activity may cause
headaches, blurred vision, nosebleeds, or con-
vulsions. Know your participants well!
• Collaborate with nursing assistants or exercise
technicians to monitor blood pressure before
and after exercise.
• If postexercise blood pressure is higher than
usual or any unusual symptoms have occurred,
urge the participant to contact her physician.
• If resting blood pressure exceeds 200/120 or
resting heart rate is different than the typical
pattern, the participant should not engage in
physical activity.
• Isometric exercises (like pushing against an
immovable object) should be used with extreme
caution by individuals with hypertension.
• Individuals with sickle-cell disease may need
medical attention if they display symptoms such
as jaundice, pain, aching bones, swollen joints, or
fatigued and labored breathing (Surburg, 1995).
Physicians must approve the activity intensity for
individuals with sickle-cell disease.
• Individuals with hemophilia need medical
attention if injuries to the head, neck, and chest
occur or if swelling of the joints or bleeding will
not cease. Individuals with hemophilia should
not take aspirin and should also avoid jumping
and high-impact and contact sports.
• Staff should be prepared for emergencies,
including having access to medical emergency
200 Adapted Aquatics Programming

numbers and training in first aid, CPR, and

automated external defibrillators (AEDs). Staff
should also be knowledgeable of the medica-
tions the participant is taking and the possible
side effects.

Goals to Target
Improve cardiovascular function within limitations.
Develop an aquatic fitness routine that is safe, suc-
cessful, and satisfactory to the participant.

Contractures and Limitations

to Range of Motion

Common Related Conditions

This attribute is commonly seen in individuals who
have
❚ scar tissue from burns or traumatic injuries,
❚ amputations with a stump close to a joint,
❚ cerebral palsy,
❚ multiple sclerosis,
❚ spinal cord injury,
❚ traumatic brain injury,
❚ arthritis,
❚ hemophilia,
❚ joint replacement,
❚ sports injury,
❚ osteoporosis,
❚ osteogenesis imperfecta,
❚ paralysis or paresis,
❚ a history of polio,
❚ a previous mastectomy, or
❚ a history of coma.
A contracture develops when the muscles and con-
nective tissue around a joint become abnormally short
and thus severely limit the joint’s range of motion
(ROM). The joint often becomes rigid, flexed, and
resistant to stretching and relaxation exercises. Con-
tracted joints limit mobility, flexibility, and functional
skills necessary for work, play, and self-care (see figure
9.2). If you notice a contracture developing in a young
child or an individual recently injured, discuss your
observation with the caregiver and the swimmer’s
physical or occupational therapist (if you have per-
mission to share this information). You can tell that
a joint is developing a contracture when you notice
a progressive decrease in ROM over time. Contrac-
Figure 9.2  Contractures, such as in this wrist, limit range
of motion.
tures may result from neuromuscular pathology (e.g.,
multiple sclerosis), nervous system dysfunction (e.g.,
spinal cord injury), joint damage (e.g., hemophilia,
arthritis, or trauma), brain injury (e.g., cerebral palsy,
traumatic brain injury, or cerebrovascular accident),
or any condition that causes muscular weakness
on one side of the joint or pathological muscular
hypertrophy. Muscles used against gravity, such as the
muscles in the front of the leg (shin) that help keep
feet dorsiflexed, may be damaged, permitting gravity
to cause the foot to drop (plantar flexion). In general,
many individuals do not experience pain from con-
tractures, but some individuals with arthritis or other
joint degeneration disorders may. Warm water helps
relax contractures, thereby making swimming an
activity of choice for people who have them. More-
over, aquatic activities and swim strokes performed
underwater can increase ROM in joints due to the
ease of movement and decreased pain experienced
in the water (Dulcy, 1983a). Thus, very often a person
with joint pain can exercise by using fun aquatic
activities instead of land activities that may be painful
and less effective due to gravity. Another benefit of
water that can assist individuals with contractures or
poor ROM is that it affords a wider range of positions
in many different planes (Dulcy, 1983a).
Teaching Tips
Some of the following tips were gleaned from the
National Multiple Sclerosis Society: Aquatic Exercise
Program (1993) handbook:

• Provide appropriate aquatic activities for
individuals with plantar-flexion contractures
(pointed toes), including walking with exagger-
ated heel strike; walking downstairs backward
to enter the pool; and leaning forward facing
the pool wall, about 3 feet (0.9 meters) from
the wall, with heels on the ground and hands
on the wall.
• Perform activities very slowly during the initial
warm-up.
• Encourage participants to move through a full
ROM.
• Ask permission before helping participants
move.
• Never force movement in a joint or extremity.
• Let movement be facilitated by the effects of the
water and the participant’s actions, providing
support and stabilization to other body parts
as needed.
• Have participants perform activities in a stand-
ing position with feet flat.
• Encourage a 3- to 5-minute swim or walking
warm-up before stretching.
• Make stroke adaptations based on limited ROM.
One such example is adapting strokes for indi-
viduals with forward shoulders who have tight
chest muscles (pectorals) and weak (lax) upper
back muscles (upper back extensors). These
swimmers will have trouble with recovery in the
front crawl, full extension during the glide in the
breaststroke, and full shoulder circumduction in
the back crawl. See the section on enhancing
flexibility in chapter 10 for more information
on ROM. Encourage the individual to use an
underwater recovery.
• Modify the front crawl for swimmers who have
poor ROM in their shoulders or neck by having
them exaggerate the body roll to achieve arm
recovery with exaggerated rhythmic breathing
to one side or having them roll over to the back
to breathe.
• Encourage participants to find what works for
them, but do not allow exaggeration to body
position that further compromises a streamlined
form unless it is necessary. Possibly place a flo-
tation device at the hips or between the knees
to keep the body horizontal.
• Modify the breaststroke to allow the hands to be
slightly apart during the glide phase, as people
with limited ROM in their shoulders may not be
Specific Needs of Adapted Aquatics Participants 201
able to streamline themselves during the glide
portion of the breaststroke.
• Modify the back crawl for decreased shoulder
ROM by creating more body roll, which allows
the participant to place the arms in the water
without needing as much ROM.
• Use a snorkel to enhance breathing when neck
ROM is limited.
• Use fins to facilitate hip extension in the supine
position for participants with limited hip exten-
sion, but don’t try to add resistance such as this
to anyone with a lower body injury or joint
replacement.
• Warm up hip extensors by having people with
decreased hip extension walk backward. Also
stress the downward motion of the legs and
emphasize hyperextending the hip and not
rotating the trunk when performing the kick for
the back crawl.
• Be aware that the breaststroke kick may be
difficult for people with decreased ROM in
the internal and external rotators of the hips.
Internal rotation is needed for the beginning
of the whip in the elementary backstroke and
breaststroke kicks and external rotation is neces-
sary for the catch.
• Be aware that ROM limitations and contrac-
tures of the knee and ankle may be common
in people who use wheelchairs or crutches and
people who experience other orthopedic diffi-
culties such as muscle weakness or arthritis.
• With physician approval, use hand paddles for
participants whose wrist contractures prevent
adequate water catch due to decreased surface
area and sculling in preparation for the power
phase of the stroke.
• Adapt kicks for participants with plantar-
flexion contractures (toes pointed away from
head, toward floor) who have problems with
leg propulsion in the breaststroke, elementary
backstroke, and sidestroke and with water-
walking.
Safety Issues
Contractures generally limit smooth, voluntary move-
ments and even balance, which may cause problems
with recovery from a front-lying position. Participants
may need to roll onto their back from the front-lying
position and move to standing from the back-lying
position.
202 Adapted Aquatics Programming

Goals to Target
Encourage and incorporate swim strokes and activities
that improve or maintain ROM, increase independent
activity, and improve functional swim skills.

Hearing Loss: Deafness and

Hard of Hearing

Common Related Conditions

Common conditions resulting in deafness or hard
of hearing include
❚ meningitis,
❚ hearing loss secondary to traumatic brain
injury,
❚ congenital deafness,
❚ acquired deafness,
❚ Usher syndrome, or
❚ hearing loss secondary to Down syndrome or
cerebral palsy.

Deafness is an umbrella term used to denote people

who fall into one of the following categories: people
who are unable to hear and understand speech;
people who have difficulties hearing (are hard of hear-
ing), and people who use American Sign Language
(ASL). People who fall into the first two categories use
a lowercase d to describe themselves, while people
in the Deaf culture who use ASL use the uppercase
D. Another category of deafness includes individuals
who are unable to process linguistic information with
or without hearing aids. Levels of hearing loss are
distinguished based on performance on an audiogram
and measurement of sound in decibels. Individuals
with a moderate hearing loss have difficulty hearing
but can usually understand speech either indepen-
dently or with hearing aids or a cochlear implant.
Individuals with a hearing loss who use ASL do
not consider themselves as having a disability but as
belonging to a linguistic minority as a separate cul-
ture. You should read about the Deaf culture, learn
ASL, and communicate with individuals who are Deaf
to learn the issues surrounding their culture. As mem-
bers of a swim class, Deaf participants need aquatics
instructors who either sign or make provisions for an
interpreter. Although interpreters are important for
communication during class, you should learn to sign
so that you may develop personal relationships with
students (see figure 9.3). Usually, Deaf participants
are integrated into general aquatics programs, but if
deafness is secondary to a physical or cognitive dis-
ability, other placements may be warranted.
Figure 9.3  Use American Sign Language to communi-
cate with swimmers who are Deaf.
Teaching Tips
• When using an interpreter, remember to look
at the swimmer while speaking.
• Keep in mind that short sentences are easier to
speech-read.
• Don’t have participants face the sun or direct
light during explanations and demonstrations.
• Be aware of the glare of light on the water,
which greatly reduces the visibility needed to
watch demonstrations or see interpreters.
• If a participant speech-reads, accommodate
her need to see the instructor at all times, for
example by placing her toward the front of the
group during demonstrations.
• Avoid placing your hands in front of your
mouth, speaking with your back to partici-
pants, or having another person demonstrate
at the same time you are talking, as it is hard
to watch the demonstration and the interpreter
at the same time.
• Provide a dry place to store hearing aids.
• Employ many visual aids.
• Use hand signals to stop and start activities.

• When using water safety videos or DVDs, make
sure the closed-captioned option is selected on
the TV, VCR, or DVD menu.
• Use e-mail, text messaging, and instant messag-
ing for distributing information outside of class.
• Stand in one area while instructing so that
the interpreter does not have to follow you
around, as interpreters typically stand near the
speaker.
• Rephrase any sentence that speech readers
do not initially understand. Develop a private
signal for a participant to use to let you know
that he didn’t understand in order to reduce his
embarrassment.
• When addressing participants who are hard
of hearing, make sure that you have their full
attention before giving directions.
• Each state has an 800 number that connects
you to a relay system and allows you to com-
municate with a Deaf person who uses a TDD,
if you don’t have access to one.
Safety Issues
• If the vestibular mechanisms in the inner ear are
damaged or if deafness is a result of a sensori-
neural loss, balance problems may result.
• Since auditory emergency signals are not
useful, establish a visual sign to get attention.
Make sure that the aquatic facility has visual
signals (flashing lights) in addition to auditory
fire alarms.
Goals to Target
Strive to help participants improve balance (if nec-
essary), improve self-confidence and leadership in
inclusion programs, and develop or maintain social
skills in a group.
Hearing Loss: Deafblindness
Common Related Conditions
Deafblindness occurs in individuals with
❚ CHARGE syndrome or
❚ Usher syndrome
Conditions commonly associated with deafblindness
depend on the etiology of the deafblindness. For
example, some conditions may be acquired through
maternal conditions, such as infection with rubella,
drug and alcohol abuse, and sexually transmitted dis-
Specific Needs of Adapted Aquatics Participants 203
ease, and some may be acquired after birth as a result
of meningitis or scarlet fever. Commonly, individuals
who have Usher syndrome exhibit deafblindness.
Individuals with a combination of visual and hear-
ing issues may be referred to as deafblind (D/B) or
multisensory deprived (MSD). Individuals who are
D/B may have residual hearing and vision or may be
totally deaf and blind (Lieberman & Cowart, 1996).
Communication may be different, as many use hand-
over-hand signing. Allow these participants to manipu-
late the aquatic environment, as they view the world
from a tactile, kinesthetic, and vestibular perspective
(Lieberman, 1996). Secondary medical characteristics
may be evident in individuals with MSD. Some of
these individuals may be mislabeled as intellectually
disabled. People who have deafblindness combined
with other disabilities may be unsuccessful in typi-
cal land-based physical activities and may need an
aquatics program in order to establish some amount
of mobility and independence (Curren, 1971). You
may have to spend a great amount of time establishing
meaningful relationships with these participants.
Teaching Tips
• Establish trust through touch.
• Provide tactile orientation to the pool area,
encouraging touching of pool gutters, ladders,
and water returns.
• Establish signs for typically used commands
and positions.
• Provide choices as part of self-determination and
empowerment (Lieberman & Stuart, 2002).
• Structure lessons to establish a typical routine.
Routine will make the participant feel safe,
helping him to achieve a sense of independence
through knowing what will happen next. Add
skills as the participant experiences success, but
still maintain a routine sequence.
• Follow skill commands by moving the person
through the motion of the skill (see figure 9.4).
Then have her feel you as you perform the
movement. Follow with the command again
and the sign for go.
• Use a similar routine and sequence until the
participant is an independent swimmer.
• Provide concrete methods of praise, such as a
handshake or pat on the shoulder, as positive rein-
forcement, since typical reinforcements like smiles
and verbal praise probably won’t be useful.
• Consciously teach each behavior and skill that
you want the individual to learn. Incidental
learning is very limited.
204 Adapted Aquatics Programming
Figure 9.4  Tactile teaching is helpful for swimmers with blindness or deafblindness.
• Take advantage of any residual vision by using
brightly colored objects.
• Do not pull or tug at a person without giving an
indication for why you are doing so.
• Establish the universal D/B sign for emergency,
which is an X drawn across the whole of the
individual’s back.
• Give the command or explanation and then
gradually move into the skill or demonstra-
tion.
• Use coactive movement, in which your body
is in as much contact as possible with the
swimmer’s body. Gradually increase the space
between your bodies (Sherrill, 2004). Link and
use signs and cues once body contact is no
longer needed.
Safety Issues
• One-on-one supervision is required for non-
swimmers who are D/B, while swimmers who
are D/B need a low student-to-teacher ratio (1
instructor per 2 or 3 swimmers depending on
residual vision and hearing and also on swim
ability).
• Be aware that disorientation may cause non-
swimmers to venture into deep water. Lifeguards
and instructors should know their swimmers.
Guide disoriented participants back to shal-
low water. Try roping off an area in the pool to
help beginners to improve orientation and to
decrease wandering into deep water.
• Don’t leave equipment scattered around the
pool deck.
Goals to Target
Individuals who are D/B should work on skills to
increase self-directed movement, to improve aware-
ness of water safety, to increase their ability to swim
without flotation devices, and to develop fitness
through increased mobility.
Head Control Difficulty
Common Related Conditions
Poor head control occurs in people who have
❚ history of stroke or traumatic brain injury,
❚ cerebral palsy,
❚ muscular dystrophy,
❚ multiple sclerosis,
❚ cervical fusions,
❚ amyotrophic lateral sclerosis (ALS), or
❚ other neuromuscular or muscular disabilities.

Individuals with limited strength in the neck (cervi-
cal) flexors or extensors, such as the sternocleido-
mastoideus, trapezius, or splenius capitis, have poor
head control. Head control is a necessity for aquatic
tasks such as rhythmic breathing, keeping the head
above water in the sidestroke, maintaining correct
body position in the backstroke, and assuming verti-
cal positions for treading water and water-walking.
Participants who lack head control cannot swim inde-
pendently; they must have assistance from another
person or from a flotation device. Some individuals
with poor head control, such as people with muscular
dystrophy, cannot strengthen their neck muscles due
to muscular atrophy. Some people, such as those with
cerebral palsy, cannot increase functional strength
due to high muscle tone. Another reason for poor
head control may be the inadequate development
of righting reactions. These reactions develop during
infancy and childhood and help the individual right
the body and head in relation to gravity. Individuals
with damaged vestibular systems may have a poor
ability to right the head.
Teaching Tips
• Develop strokes on the back, eliminating the
need for head control during rhythmic breath-
ing.
• Use a face mask and snorkel for swimming on
the front, eliminating the need for rhythmic
breathing and head control (see figure 9.5).
• Assist breathing to the front by walking or
swimming in front of the participant and
pushing up on his chest or by supporting his
chin or underarms in order to lift his head
and face.
Figure 9.5  Using a face mask and snorkel can aid a swimmer with a limited range of neck motion.
Specific Needs of Adapted Aquatics Participants 205
• Do not encourage participants with cerebral
palsy who have poor neck and head control
to breathe by lifting the head forward because
neck hyperextension may elicit primitive reflex
patterns that affect arm and leg control.
• Assist breathing to the side by pushing down
on the shoulder of the nonbreathing side in
order to rotate the participant onto her side for
breathing.
• Have the participant wear a ski belt or rescue
tube across the chest and under the armpits
(with a closing clip on the back) in order to
elevate the chest and face area (see figure 9.6)
when swimming on the front.
• Consider allowing participants to wear a flota-
tion collar to support the head above water.
• During activities, maintain a position at or near
the participant’s head so you can prevent sudden
submersion due to lack of head control.
Safety Issues
• When in a prone position, individuals must have
one-on-one assistance.
• You must know how long the person can hold
his breath and establish signals for when to help
the participant breathe.
Goals to Target
Increase the participant’s awareness of the move-
ments used to breathe and the movements used for
rhythmic breathing, improve her ability to right and
otherwise control the head, increase her comfort level
when wearing various flotation devices, and help her
improve body position while swimming.
206 Adapted Aquatics Programming
Figure 9.6  Using a rescue tube under the chest and armpits helps elevate the
participant’s face for easier rhythmic breathing.
High Muscle Tone
Common Related Conditions
High muscle tone is commonly seen in individuals
with
❚ cerebral palsy,
❚ traumatic brain injury,
❚ multiple sclerosis, or
❚ other neurological impairments.
High muscle tone (spasticity, hypertonicity) is caused
by damage in the nervous system. Strong muscle
contractions may occur spasmodically or repetitively
to interfere with voluntary motor control. In individu-
als with cerebral palsy, spasticity and the hyperactive
stretch reflex are related. “Receptors in the muscles
that control tone in the stretched muscles overreact,
causing the stretched muscles to contract” (Winnick,
1995, p. 168). Spasticity results from these abnormal
contractions and contributes to contractures and limi-
tations in ranges of motion. Spasticity is sometimes a
problem for individuals with hemiplegia, paraplegia,
or quadriplegia.
Teaching Tips
• Maintain the water temperature at 86 to 92 °F
(30.0-33.3 °C) to reduce the spastic reaction of
muscles by increasing the tendency to relax. Air
temperature should be 4 °F (2.2 °C)
higher than water temperature.
• Be aware that sometimes spasticity
causes internal rotation and adduc-
tion of legs, commonly referred to
as scissoring, which prevents walk-
ing and promotes sores between the
knees. Place a comfortable piece of
cushioning between the knees during
swimming. For the cushioning, use
partially inflated arm floats, pull buoys,
or a small black tube used by the swim
team to work on arm strokes. But if a
flotation device makes it difficult for
the individual to recover to a vertical
position, try using long tube socks (with
the feet cut out) around the knees.
• Act as a spotter near the swimmer’s
head whenever spastic movements
of the participant are sudden and
involuntary, because these movements might
cause the swimmer to submerge unwillingly or
splash herself or others.
• Plan warm-up activities, such as slow gentle
movements, gentle stretching, rotational move-
ments, walking, easy kicking, or slow swim-
ming, as these have been shown to reduce
spasticity. Consult with the participant’s physical
therapist about muscle tone management and
appropriate range of motion.
• Avoid quick movements and sudden hands-on
and hands-off movements; slow movements and
steady touch are best with persons who have
high muscle tone.
• Be aware that tactile teaching, or moving a
person’s body the way you want him to move
it, may be necessary. Frequently a participant
with high muscle tone cannot move in the way
desired. A participant may also have problems
with body image and proprioceptive input,
resulting in not knowing where body parts are
in space. Sensory input, such as that provided
through tactile teaching, can help guide the
participant through skill development and can
reduce confusion and nervousness about learn-
ing new skills.
• Keep in mind that placing the participant in the
supine position and performing lateral swaying
with a rotational motion at the end of each
sway may decrease spasticity. Two instructors
or one instructor and a flotation device near the
swimmer’s head are needed for this maneuver
(Campion, 1985).

Safety Issues
• Be aware of sudden spastic movements, which
may be dangerous during transfers in and out
of the pool.
• Although warm water is essential for relaxation,
whirlpools and saunas may be too hot for per-
sons with temperature regulation problems or
with decreased sensation due to paralysis.
• Position yourself at the head of the swimmer,
as spastic movements may cause the head to
submerge.
Goals to Target
Strive to decrease spasticity, increase voluntary motor
control, and improve quality of voluntary motor
skills. Collaborate with caregivers and physical
and occupational therapists to determine the most
efficient positioning of the body during instruction
and strokes.
Hyperactivity
Common Related Conditions
Hyperactivity is commonly seen in individuals with
❚ ADHD combined type,
❚ ADHD predominantly inattentive type,
❚ ADHD predominantly hyperactive-impulsive
type (American Psychiatric Association,
1994),
Figure 9.7  Sectioning off an area of the pool can help swimmers with hyperactivity maintain their personal space.
Specific Needs of Adapted Aquatics Participants 207
❚ learning disabilities,
❚ intellectual disability,
❚ Asperger’s syndrome,
❚ autism, or
❚ prenatal exposure to alcohol or other drugs.
Hyperactivity is an overresponsiveness to stimuli
that causes the individual to move excessively.
Typical characteristics include difficulty stand-
ing or sitting still, fidgeting, running, or excessive
climbing that occurs for at least 6 months. The
individual with hyperactivity may have problems
listening and doing written work because these
activities require staying still for a length of time.
The individual never seems to tire and may often
act impulsively.
Teaching Tips
• Decrease environmental stimuli by limiting the
number of participants in the group.
• Reduce the amount of space used for lessons
by sectioning off an area in the pool with buoys
(see figure 9.7).
• Establish a routine and keep the instructional
time structured.
• Be consistent with praise, cues, and conse-
quences.
• Don’t put out equipment until it is nearly time
to use it.
• Use bright colors to focus attention on an
object or a learning center, but avoid wearing
208 Adapted Aquatics Programming
bright bathing suits or having too many colors
overall.
• Provide relaxation activities emphasizing slow
movements and self-control.
• Follow logical skill progressions during each
lesson.
• Build success into every lesson.
• Task-analyze each motor skill, because present-
ing one small part of the skill will increase suc-
cess and avoid possible frustration that occurs
when trying to do the entire skill at once.
• Provide specific feedback on the performance
of motor skills.
• Provide positive reinforcement for each accom-
plishment.
• Be consistent with rules, procedures, task pre-
sentations, reinforcement, and punishment,
thereby setting the tone for sessions that are free
of misunderstandings and frustrations.
• Incorporate 5-minute free swims into your ses-
sions to provide less structured time and an
active outlet that breaks up times of needing to
watch and listen.
• Keep structured lessons between 10 and 30
minutes, depending on the swimmer’s atten-
tion span.
• Consult with the swimmer’s family for an
applied behavior analysis program.
• Speak with the participant in response to poor
behavior, explaining how the behavior is not
appropriate.
• Keep in mind that frequently changing activi-
ties and offering limited choices helps decrease
restlessness and increase motivation.
Safety Issues
• Consult with caregivers and refer to the Phy-
sicians’ Desk Reference (Sifton, 2006) for
prescription drugs and side effects related to
physical activity.
• Position yourself between the individual with
hyperactivity and the pool when walking on
the deck.
Goals to Target
Encourage individuals with hyperactivity to increase
movement time spent on task, increase quality of
movement, increase self-control, and improve self-
concept.
Interaction Difficulty
Common Related Conditions
Interaction difficulties are commonly seen in indi-
viduals with
❚ autism,
❚ pervasive developmental disabilities such as
Asperger’s syndrome,
❚ intellectual disability,
❚ schizophrenia,
❚ severe emotional disturbance,
❚ bipolar disorder,
❚ prenatal exposure to alcohol or other drugs,
or
❚ fragile X syndrome.
Participants with cognitive, social, or behavioral
conditions may have difficulty learning in a group.
Individuals with a multitude of behavioral conditions
and emotional disturbances require adaptations to
communication, environment, and teaching strate-
gies. Some interaction problems are withdrawal,
anxiety, noncompliance, social maladjustment,
disruptiveness, conduct disorder, self-injurious and
self-stimulatory behavior, phobia, obsession, com-
pulsion, and schizophrenia. Emotional and learning
support personnel may accompany students who are
in school-based physical education aquatics programs
and are sometimes called therapeutic support staff
or wraparound staff.
Teaching Tips
• Provide clear limits and rules that participants
can understand and achieve.
• Provide structure and routine within the aquat-
ics lesson.
• Be consistent with cues, rules, and conse-
quences.
• Tell or ask participants about what you are going
to do before touching them during hands-on
teaching.
• Reinforce appropriate behavior with specific,
positive praise.
• Check with caregivers as to appropriate conse-
quences and applied behavior analysis plans.
• Since eye contact may be difficult for some
children with behavior disorders, you may
need to physically move the participant, if he
tolerates it.

• Start with a very small group of 2 or 3 and move
to a larger group if the participant feels comfort-
able and is learning.
• Collaborate frequently with caregivers and
school, vocational, or rehabilitation personnel
to determine the proper approach to behavior
management.
• Teach participants to demonstrate respect for
themselves, others, and property.
Safety Issues
• Since biting, scratching, or hitting may be
exhibited by people with extreme interaction
problems, make sure your tetanus and hepatitis
shots are updated.
• Know the medications the participant takes
so that you may note, report, or prevent side
effects.
• Be aware that some participants with interac-
tion problems do not possess danger awareness
skills. This can be a safety issue in the pool area
due to deep water, slippery decks, and diving
boards.
• Emotional lability (mood swings) in some indi-
viduals with interaction problems may cause
the participant to be happy one moment and
have a crying tantrum the next. Be alert for
spontaneous, impulsive behavior.
Goals to Target
Individuals with interaction problems need to
increase their ability to solve problems, improve
their ability to make positive choices, increase their
awareness of others’ feelings and rights, increase self-
direction, improve safe swimming behavior, increase
the number of people socialized with, improve
self-esteem through success in swimming, improve
independence in the aquatic environment, decrease
inappropriate behaviors, increase awareness of dan-
gers in the aquatic environment, increase self-control,
and improve quality of swim skills.
Joint Dysfunction
Common Related Conditions
Common disabilities associated with joint dysfunc-
tion include
❚ osteoarthritis,
❚ rheumatoid arthritis,
Specific Needs of Adapted Aquatics Participants 209
❚ juvenile rheumatoid arthritis,
❚ fibromyalgia, and
❚ lupus.
A joint is an articulation of two bones with a smooth
inner lining or fluid sac called the synovium and an
enclosure of fibrous outer tissue called the capsule
(Blauvelt & Nelson, 1994). Disease, trauma, or
degenerative disabilities can cause joint dysfunction
and changes in joint structure. Infection, inflamma-
tion, and trauma may lead to loss of joint function or
severe limitations to ROM, such as joint contracture
(see also Contractures and Limitations to Range of
Motion on page 200).
Joint complications such as arthrogryposis pro-
duce stiffness and joint deformity, whereas arthritis is
manifested by stiffness, swelling, pain, and soreness.
Weak muscles surrounding the joints result from and
are complicated by not moving the joints through
their normal ROM during activities of daily living
and leisure activities. Experts strongly recommend
swimming and other aquatic activities for people
with joint dysfunction.
In this section, we focus on joint dysfunction due
to arthritis and joint replacement. Teaching tips, safety
information, and goals to target for individuals with
arthrogryposis are located in the Contractures and
Limitations to Range of Motion section on page 200,
since this joint dysfunction is also known as multiple
congenital contractures.
Teaching Tips
• For ROM limitations and contractures, see the
contracture section in this chapter.
• Pain tolerance, swelling, and ROM may change
daily, so communicate with the participant
frequently and adapt activities to changing
symptoms.
• Avoid activities that compress the bones and
joints, such as jumping and contact activities.
• Offer aquatic activity that lends itself to increas-
ing ROM in as many joints as possible.
• Perform exercises and activities slowly under-
water.
• Provide weight-bearing activities in the water.
• Offer less strenuous activities during more
painful days.
• Monitor postactivity condition to determine the
next session’s plan.
• Use isometric exercises to strengthen the
muscles around a joint.
210 Adapted Aquatics Programming
• Stretch after the entire body is warmed up.
• Use aquatic activities consistently and regu-
larly.
• Consult a physical therapist to devise appropri-
ate swim plans.
• Have swimmers avoid tight swimsuits and over-
sized T-shirts in the pool as both limit freedom
of movement.
• Plan for gradual increases in activity frequency,
intensity, and time.
• Avoid excessive fatigue, fast movements, and
intense, competitive atmospheres.
• Avoid excessive back extension, such as prone
strokes with the face out of the water.
• Be aware that although warm water (86-92 °F,
or 30.0-33.3 °C) is most often recommended
for joint dysfunction, some participants may
feel better in cooler water.
• Provide a water table, tot dock, or chair in the
water for resting.
Safety
• Protect against falling, bumping, and colliding
with equipment or others.
• Pain and limited ROM may be manifested by
movement difficulties.
• Provide hydraulic lifts and easy-access stairs
with wide and gradually descending steps.
Many participants with arthritis may fall trying
to get their feet on the small recessed ladders
found in most pools.
• Install handrails and handgrips in and around
the pool for balance during activities and
transfers.
• Do not encourage participants to work through
the pain.
Goals to Target
Individuals with joint problems should strive to
increase the frequency, intensity, and duration
of aquatic activities performed without pain;
strengthen muscles around affected joints; improve
or maintain ROM; improve cardiorespiratory
endurance, balance, and functional gait; increase
tolerance for bearing weight and independence;
prevent further contractures; and reduce pain and
inflammation.
Kinesthetic System Disorder
Common Related Conditions
Kinesthetic system disorders are manifested in indi-
viduals with
❚ traumatic brain injury,
❚ history of stroke,
❚ severe learning disabilities,
❚ intellectual disability,
❚ cerebral palsy,
❚ neuromuscular disabilities,
❚ autism,
❚ other pervasive developmental disabilities,
❚ prenatal exposure to alcohol and other drugs,
or
❚ developmental coordination disorder.
Sensory stimuli enter the kinesthetic system via mus-
cles, tendons, and joints, letting us know where the
body and extremities are in space and how they are
moving. Disorders in input and interpretation cause
deficits in movement (dyskinesia) because the body
and its extremities cannot interpret where they are in
space or at what speed they are moving. Individuals
who cannot identify where the body is while swim-
ming will demonstrate inconsistent movements and
skills, as corrections in stroke mechanics are based
on being able to feel subtle changes in arm, leg, and
trunk angles and in the speeds at which movements
are accomplished.
Teaching Tips
• Create turbulence around an extremity to
increase awareness of its position in space.
• Use physical assistance to guide the participant’s
active movements.
• Be aware that mild joint pressure (such as from
jumping up and down) and bearing weight
(such as when doing a handstand) increase
awareness of extremities.
• Provide activities through which you challenge
the person to vary swimming speed.
• Attach a 5-foot-long (1.5-meter) piece of sur-
gical tubing to a weightlifter’s belt. Have the
swimmer wear the belt and tie the tubing to the
gutter. Have the swimmer try to swim away on
this tethered line; doing so creates increased
awareness of the body and its movements.

• Ask participants to bring in old clothes and
swim or walk in neck-deep water. The weight
of the clothes provides increased awareness that
can help them feel stroke corrections until the
correction is more automatic.
• Attach light water weights to a body part to
increase kinesthetic awareness.
Safety Issues
Lack of awareness of body parts causes the individual
to be clumsy, and therefore he may bump into others,
lane lines, or the wall when swimming.
Goals to Target
Individuals with kinesthetic system disorders need
to increase their body awareness and understand-
ing of how body parts function for swimming and
water safety, increase their awareness of both sides
of the body and how they work together (laterality),
improve their directionality (awareness of the body
in relation to objects), and increase their ability to
cross the midline by making 90° turns while swim-
ming on their front.
Memory and Understanding
Difficulty
Common Related Conditions
Memory and understanding issues may be seen in
individuals with
❚ intellectual disability,
❚ traumatic brain injury,
❚ severe learning disabilities,
❚ history of stroke,
❚ autism,
❚ other pervasive developmental disorders,
❚ fragile X syndrome,
❚ Down syndrome, or
❚ prenatal exposure to drugs.
Memory and understanding problems may be a pri-
mary disability or secondary to other disabilities. The
diagnosis of cognitive impairment or intellectual dis-
ability typically applies to understanding and the abil-
ity to recall previously learned tasks. A participant’s
primary disability may be a physical disability, such
as cerebral palsy, but secondary problems may also
exist, such as disorientation, memory deficit, and cog-
Specific Needs of Adapted Aquatics Participants 211
nitive impairment. Thus, you must be able to assess
the individual’s ability to follow multistep directions,
and the swimmer needs to be able to understand what
you are requesting, perform the task, and remember
the task for use at a later time.
Difficulties with understanding directions and
problems with memory interfere with the develop-
ment of health-related physical fitness and the acqui-
sition of motor skills. If a participant cannot recall how
to perform a skill from session to session, you may
have to plan for adequate repetition. If a participant
has a problem understanding, she may learn the skill
immaturely and store it incorrectly in the memory.
Thus, you must work to help the participant maintain
and generalize the skills she has learned. This takes
careful planning and continuous spot-checking for
skill retention (Jansma & French, 1994). To facilitate
generalization, have the participant try the skill in
different situations, such as in a game, in the deep
end, in another setting (e.g., home pool), and with
another instructor.
Teaching Tips
To help you better serve individuals with memory or
understanding issues, we have divided the teaching
tips into three parts: Memory Difficulties, Generaliza-
tion, and Poor Understanding of Information.
Memory Difficulties
• Use verbal cues (“Move arms now”) often.
• Model the desired position, as visual cues can
prove invaluable, and have the participant
copy.
• Be aware that tactile cues are often the best for
cueing a person who does not remember what
to do next; for example, tap the person on the
shoulder to cue breathing at the right time.
• Have the participant carry notebooks into the
locker room and pool area to help remind him
of rules, duties, or steps for dressing.
• Use Plexiglas and grease pencils to create a list
of the tasks the participant must accomplish
and stand this list by the pool edge. As each
task is completed, encourage the participant
to check it off (see figure 9.8). This keeps the
person oriented to what is going on.
• Use lap counters to help the participant keep
track of laps.
• Use a kitchen timer to help a person know
when to leave or how much time he has spent
on a task.
 212 Adapted Aquatics Programming
Photo courtesy of Monica Lepore
Figure 9.8  Using appropriate memory devices can help an individual become an
independent swimmer.
• Consistency, repetition, and review are good
strategies to increase memory.
• Post written handouts and lesson or skill check-
lists in the pool area to show completed tasks
and successes.
• Use basic orientation questions (“Where is
the best place to enter the lap pool?”) at each
session.
• Use visual imagery to facilitate recall.
• Employ as many sensory modalities as possible,
but do not use them all at once.
• Simplify, demonstrate, and repeat.
• Use a hierarchy of cues. For example, start with
a nonverbal cue, and if that doesn’t work, move
on to more intrusive cues, such as verbal cues,
visual modeling, and finally physical assistance
(see figure 9.9).
• Use few and simple words.
Generalization
Many professionals feel that generalization of skills is
impossible for individuals with severe memory and
understanding problems. Strive for an interdisciplin-
ary approach, incorporating words, cues, and rein-
forcements that are used in other areas of the person’s
life. Specifically relate what the participant is doing
in the pool to what she does in her life.
• Remember that the swimmer will need much
cueing to generalize skills.
• Have the participant practice the
skills in as many situations as pos-
sible.
• Use questioning to discuss ways
in which the participant may use
aquatic-related skills in other situ-
ations.
• Have the participant role-play and
discuss how a skill might apply in
various situations.
Poor Understanding of
Information
• Start with one-step directions and
gradually move on to two- and
three-step directions.
• Repeat directions or ask the swim-
mer to repeat directions.
• Keep in mind that a sterile environ-
ment, devoid of as many visual and
auditory stimuli as possible, is best.
• Give additional time for processing after giving
a command or asking a question; keep in mind
that you may have to wait for a reply for more
than 30 seconds.
• Provide visual and verbal prompts instead of
long explanations.
• Utilize age-appropriate explanations when
working with an adult. Speak in a mature
manner and use simple phrases; do not use
baby talk.
• Modify the pace of your communication if you
are a fast talker—slow down but don’t exagger-
ate the slowness.
• Inform participants of class expectations daily.
Safety Issues
• Emphasize and repeat safety directions. Never
assume that any safety issue is minor. Accident
prevention is an abstract issue to this group.
• Be specific about simple rules. Cause-and-effect
relationships are hard to understand.
• Demonstrate and use verbal and physical cues
for safety information to make safety issues
come alive.
Goals to Target
Individuals with poor memory or understanding
of directions need to improve their ability to follow
multistep directions; recall safety rules; generalize

Photo courtesy of Camp Abilities Tucson
Figure 9.9  Giving a physical prompt is a concrete
means of teaching someone who has difficulty under-
standing verbal language.
aquatic skills to home pools, beaches, and other com-
munity facilities; and understand directions while in
a large group. In addition, increase their awareness
of safety issues and independent swim skills.
Multisensory Loss
See Hearing Loss: Deafblindness on page 203.
Oral Motor Dysfunction
Common Related Conditions
Oral motor dysfunction is commonly seen in indi-
viduals with
❚ low muscle tone (such as Down syndrome),
❚ high muscle tone and primitive reflexes (such
as in cerebral palsy),
❚ severe multiple disabilities,
❚ history of stroke,
❚ hemiplegia,
❚ intellectual disability, or
❚ traumatic brain injury.
Specific Needs of Adapted Aquatics Participants 213
Lip closure and breath control are essential for suc-
cessful aquatics participation. Individuals who have
difficulty with these skills may be participants with
neuromuscular disabilities that affect the facial mus-
cles or people who have experienced facial trauma.
Individuals with oral motor dysfunction tend to drink
or choke on the water instead of keeping their lips
closed and exhaling.
Teaching Tips
• Use activities that stress blowing against resis-
tance, such as blowing Ping-Pong balls (see figure
9.10), making bubbles with the mouth in the
water, and blowing up floats and beach balls.
• Discuss with caregivers the possibility of having
toddlers and preschoolers who have problems
drinking pool water hold pacifiers in their
mouths to encourage lip strength and decrease
the amount of pool water they drink.
• Manually facilitate lip closure by gently using
your fingers above the top lip and below the
bottom lip while giving the verbal cue, “Close
your lips.”
• Encourage the participant to say certain sounds,
such as “MMM” and “PPPPP.”
• Provide support for individuals whose disability
prevents lip or mouth closure but who can effec-
tively close their throats to prevent swallowing
or inhaling water.
• Encourage the participant to flex the head
slightly, because this may help with lip closure.
When the head is in extension and the partici-
pant is lying on her back, the mouth tends to
open.
• Provide consistent hands-on stability for par-
ticipants who need it. Unstable positions in the
water or a feeling of falling causes the body to
stiffen, the arms and legs to involuntarily extend
and flex, and the mouth to open.
Safety Issues
Excessive drinking of pool water due to poor oral
motor control (or low environmental awareness due
to cognitive impairment) may lead to vomiting, diar-
rhea, and even hyponatremia (a sodium imbalance) in
individuals who are small in stature and low in weight
(infants, toddlers, young children, and small adults).
Goals to Target
Individuals with poor oral motor coordination should
perform activities to improve lip closure, increase
214 Adapted Aquatics Programming

Figure 9.10  Blowing Ping-Pong balls helps improve oral motor control.

facial muscle tone, and improve breath control. Addi- muscle strength and endurance. Atrophy refers to
tional goals to target are to increase the awareness of wasting away or shrinking muscle tissue due to disuse,
lips, mouth, and facial movements and to decrease disease, trauma, bed rest, infection, or tumor. Paralysis
the drinking of pool water. and atrophy lead to changes in muscle tone, ROM,
ambulation, organ function, sensation, health-related
physical fitness, and motor skills. Other complications
may result in postural problems, hypotension, pres-
Paralysis, Paresis, and Atrophy sure sores, bone ossification, and blood clots (Garvey,
1991). Depending on the source of the paralysis or
paresis, a variety of symptoms may be present that
Common Related Conditions vary from one disability to the next.
Paralysis, paresis, and atrophy are commonly seen
in individuals with Teaching Tips
❚ traumatic brain injury,
• Develop the means for modifying the stream-
❚ history of stroke, lined position, as paralysis alters floating and
❚ spinal cord injury, gliding positions. Changing head position
❚ orthopedic disabilities, and attaching flotation devices or weights to
❚ history of prolonged bed rest with lower or raise body position may be some
immobility, modification strategies. Achieve a balanced
❚ multiple sclerosis, body position by experimenting within proper
safety limits.
❚ spina bifida,
• Modify swim strokes, water entries, and water
❚ muscular dystrophy, and
safety skills on an individual basis after deter-
❚ myasthenia gravis.
mining the participant’s trunk stability, limb
strength and endurance, and head control.
Paralysis is caused by interrupted nerve innervation
between the brain and muscles as a result of birth • Encourage independence in all areas of the
defects, disease, tumors, trauma, or infection. Paraly- aquatic experience, including self-care.
sis usually refers to loss or impairment of voluntary • Modify lesson plans to account for extra time
muscle function, while paresis refers to incomplete needed in self-care, locker-room activities, and
loss of voluntary muscle function leading to low pool entries.

• Alter body position by placing a lightweight
belt around the swimmer’s hips. Individuals
whose legs are atrophied and have little muscle
weight often have legs that float excessively. This
affects streamlined body position and makes it
difficult to obtain an efficient rhythmic breath-
ing position.
• Check skin for abrasions before and after swim-
ming. Individuals with paralysis often have
decreased sensation.
• Provide gym mats on the pool deck so that
people who need to scoot around the pool deck
may do so without experiencing abrasions.
• Alter body position if you suspect an increase in
body fat is due to passive lifestyle or decreased
muscle mass.
• Modify lessons to include frequent rests if
fatigue is evident due to disabilities causing
muscle degeneration (e.g., muscular dystrophy,
Lou Gehrig’s disease). Other factors causing
fatigue may include deconditioning due to
excessive sitting and bed rest.
• Encourage use of aqua socks to decrease abra-
sions caused by transferring and scraping feet
when swimming.
• Check with a physician for specific movements
you can use to improve posture, if atrophy has
caused posture problems (see also Posture Dis-
order on page 216).
• Adapt the timetable of your lesson plan to allow
for muscle spasms and various neurological
sensations sometimes interrupting the aquatics
session.
• Encourage the participant to communicate with
a physician about medications and their effects
on exercise heart rates and fatigue.
• Become knowledgeable of proper assistance
in taking off and putting on braces and other
orthotic devices.
• Adapt activities and swim strokes to work within
trunk ROM limitations, as individuals with para-
or quadriplegia may have had spinal fusions
or other operations performed to stabilize the
Safety Issues
spine.
• See the section Contractures and Limitations to
Range of Motion on page 200, as contractures
are common among individuals who experi-
ence problems with muscle tone.
• Modify cardiorespiratory activity if respiratory
function is compromised, such as in people
with muscle-weakening disabilities like mus-
cular dystrophy or in people with high cervical
Specific Needs of Adapted Aquatics Participants 215
spinal cord injuries. In addition, keep in mind
that these participants may be shallow breathers
and find coughing difficult.
• Place special emphasis on upper-body devel-
opment. Include strengthening of deltoids and
stretching of pectorals.
• Be aware that stabilization of other body parts
or the trunk—such as belting lower extremities
together—may be necessary for the swimmer
to focus on one part of the body.
• Alter stroke mechanics as necessary due to
uneven muscle strength and abnormal centers
of gravity and buoyancy. Change stroke as little
as possible from normal efficiency. Use trial and
error to compensate for structural inefficiencies,
limited ROM, uneven strength, and a variety
of other problems. Try having the participant
use smaller ROM or sculling arm movements.
See chapter 8 for more information on stroke
modifications.
• Encourage participants to approach a turn at
the wall (lap swim) from an angle and to use
arm push-offs.
• Encourage the participant to use a mask and
snorkel or to roll over onto the back to breathe
if upper-body impairment causes difficulty lift-
ing or turning the head. Initially, teach the back
crawl or elementary backstroke.
• Experiment with using hand paddles, as these
may help with weak hand function by increas-
ing surface area.
• Experiment with using fins if the upper body is
weak and the lower body has some movement,
but keep in mind that fins can be heavy and
burdensome.
• Be aware that the sidestroke may be difficult
for individuals with lower-body paralysis and
atrophy due to difficulty with trunk balance
in the water. Keep in mind the importance of
the scissor kick for forward propulsion in this
stroke.
• Refer individuals with decubitus ulcers, or
pressure sores, to land-based physical activities
rather than aquatics, due to risk of infection.
• Ensure that individuals with halo braces are
medically stable and that the linings of the
braces are replaced after swimming. Avoid get-
ting the head wet.
• Avoid participation of individuals whose
extremely low blood pressure or autonomic
216 Adapted Aquatics Programming
dysreflexia (as exhibited by many people with
quadriplegia) impedes their on-land therapy
treatments (Garvey, 1991).
• Ensure that all excretion collection bags are
emptied before swimming.
• Check skin frequently, as decreased sensation
leads to unnoticed bruising.
• Avoid prolonged heat and cold and sudden
temperature changes.
• Realize that paralysis, atrophy, and paresis can
be caused by a host of disorders and that swim-
mers who have atrophy due to traumatic spinal
cord injury may need warm water (over 86 °F, or
30.0 °C) to feel comfortable, while people with
multiple sclerosis, who have a different cause
of atrophy, may need a cooler pool (under 86
°F, or 30.0 °C).
Goals to Target
Individuals with paralysis or atrophy should perform
activities that increase balance and trunk stability,
improve aerobic endurance, encourage weight bear-
ing (if feasible), increase the number of pain-free posi-
tions, and develop independence. In addition, help
these individuals develop swim skills that increase or
maintain ROM and strength and improve ambulation,
circulation, and transfers.
Posture Disorder
Common Related Conditions
Scoliosis is commonly seen in individuals with
❚ differing leg lengths,
❚ spina bifida,
❚ osteogenesis imperfecta, or
❚ dwarfism, such as spondyloepiphyseal dys-
plasia.
Lordosis is commonly found in individuals with
❚ myelomeningocele spina bifida,
❚ muscular dystrophy,
❚ polio,
❚ paraplegia,
❚ cerebral palsy,
❚ spondylolisthesis, or
❚ osteogenesis imperfecta.
Kyphosis is commonly associated with
❚ older women (due to osteoporosis),
❚ individuals who are blind (due to walking with
shoulders and head forward when using a
cane or having a dog pulling them),
❚ individuals in wheelchairs (due to leaning and
pushing forward),
❚ cerebral palsy,
❚ Scheuermann’s disease,
❚ quadriplegia,
❚ juvenile rheumatoid arthritis,
❚ dwarfism conditions (such as spondyloepiphy-
seal dysplasia and diastrophic dysplasia),
❚ osteogenesis imperfecta,
❚ Friedreich’s ataxia, and
❚ spina bifida.
Problems with posture may be a primary result of
an orthopedic disability or a secondary result of a
neuromuscular disorder. Posture disorders such as
kyphosis, lordosis, or scoliosis may be functional,
caused by lifestyle habits such as day-to-day use of
improper body mechanics, but proper exercise and
conscious changes in walking, sitting, and standing
alignment may correct them. Posture disorders may,
however, be structural; structural problems can only
be corrected through surgery or other medical inter-
vention, such as electrical stimulation.
Kyphosis is an extreme flexion of the thoracic ver-
tebrae that causes the upper back to be humped, or
rounded. The muscles that extend the upper back are
weak and the pectorals may be tight as a result.
Lordosis is an extreme hyperextension of the
lumbar spine that causes a hollow lower back, or
swayback. Lordosis is typically seen when the muscles
of the abdomen are weak and lax, the gluteal muscles
are weak, and the hip flexors and lower back muscles
are short and tight. This combination causes the pelvis
to tip forward, and the body compensates by leaning
back, causing swayback. Lordosis is also prominent
when muscles are paralyzed in the pelvis area.
Scoliosis is a curvature of the spine in which the
vertebrae are rotated and tilted to the side. Muscles
on the tilted side of the back are short and tight
while the muscles on the other side are weak and
elongated, or lax.
Posture problems that affect the trunk cause poor
body alignment during aquatics and other physical
activities, poor functioning of internal organs, and
sometimes, pain. A severe posture problem affects
breathing and flexibility.
Teaching Tips
• Integrate the swimmer’s home exercise program
into the aquatics program.

• Encourage strokes that stress even muscle devel-
opment, including the following:
– Breaststroke with wide arm sweep—helps improve
symmetry in people with scoliosis and stretches
chest muscles in people with kyphosis.
– Double-arm backstroke—helps improve sym-
metry in people with scoliosis and stretches chest
muscles and strengthens upper back muscles in
people with kyphosis (see figure 9.11).
• Emphasize proper posture, stretching, and
strengthening of both sides of the body.
• Capitalize on swimming time; it may be the
only time individuals who use back braces
take them off.
• Discuss any ROM limitations with the partici-
pant, caregiver, and physician. An individual
who has had spinal surgery generally has
limited ROM.
• Adapt strokes and aquatic activities as needed
to accommodate ROM limitations.
Safety Issues
In juvenile kyphosis (Scheuermann’s disease), vigor-
ous flexion of the trunk is contraindicated in the acute
stage of the condition.
Goals to Target
Individuals with posture problems should perform
activities that improve flexibility in tight areas,
Figure 9.11  The double-arm backstroke can strengthen muscles in the upper back.
Specific Needs of Adapted Aquatics Participants 217
enhance swim strokes to the best of personal limits,
strengthen the targeted muscle groups, decrease pain,
and increase body awareness.
Primitive Reflex Retention
Common Related Conditions
Primitive reflex retention is commonly found in indi-
viduals with
❚ cerebral palsy,
❚ traumatic brain injury,
❚ history of stroke,
❚ neurological impairment,
❚ severe learning disabilities, or
❚ severe intellectual disability.
Primitive reflexes are normal, involuntary spinal cord
and brain stem motor responses to stimuli. During
infancy, primitive reflexes such as the grasp reflex,
Moro reflex, asymmetrical tonic neck reflex (ATNR),
and symmetrical tonic neck reflex are inhibited by
the maturing of the central nervous system (CNS) and
replaced by righting and equilibrium reactions and
coordinated, voluntary motor output. When the CNS
fails to mature due to brain damage, the individual
may retain these primitive reflexes, which then inter-
fere with normal, orderly motor development, pos-
ture, and voluntary motor control. Involuntary reflexes
can affect muscle tone and compromise balance.
 218 Adapted Aquatics Programming
Teaching Tips
• Encourage positions that inhibit reflexes, such
as a neutral head position or a slightly tucked
chin position with the head in the midline of
the shoulders and the hips and knees slightly
flexed.
• Use symmetrical activities (activities requiring
both sides of the body to do the same thing at
the same time) such as the breaststroke, the
elementary backstroke, the inverted breast-
stroke, finning, and sculling.
• Use caution with the scissor kick and flutter
kick, as these kicks tend to promote the crossed
extension reflex, causing nonfunctional abduc-
tion or scissoring of legs.
• Use caution in supine positions, as neck
extension stimulates the symmetrical tonic
neck reflex, causing arms to extend and legs
to flex.
• Consult with a physical therapist as to proper
positioning of the body for increased extremity
control (see figure 9.12).
• See Harris (1978) for further information about
positions for head and jaw control.
Photo courtesy of Shawn Stevens
Figure 9.12  Proper positioning of swimmers with primitive reflexes
breaks up postural patterns and improves voluntary motor control.
• Be aware that rhythmic breathing to the side
in the front crawl may be impossible for swim-
mers with severe ATNR retention. Turning the
head to the side causes limbs on the face side
to extend and limbs on the skull side to flex,
thereby eliminating propulsion. Swimmers with
mild ATNR retention may be able to rhythmi-
cally breathe to the side without experiencing
interference with the stroke.
Safety Issues
• Be aware that when swimming prone, individu-
als with tonic labyrinthine reflex retention will
have difficulty raising their heads to breathe.
• Remain at the participant’s head, as the position
of the head and neck controls most movements
in people with primitive reflex retention.
• Keep in mind that sudden noises, movements,
or splashing may cause sudden reflex activity,
possibly causing the participant to lose a safe
position and submerge.
• Guard against sudden submersion of the face
while the participant is in the supine position.
Goals to Target
Individuals with reflex retention problems should per-
form swim strokes and aquatic skills that increase arm
and leg coordination, control proper body position-
ing, and improve functional, independent swimming
and voluntary motor control.
Proprioceptive Disorder
See Kinesthetic System Disorder on page 210.
Range of Motion Dysfunction
See Contractures and Limitations to Range of Motion
on page 200.
Receptive or Expressive
Language Disorder
See Overcoming Communication Barriers on page
132 of chapter 7.

Respiratory Disorder
Common Related Conditions
Common disabilities associated with respiratory
disorders include
❚ chronic obstructive pulmonary diseases
(COPD),
❚ cystic fibrosis,
❚ ankylosing spondylitis,
❚ kyphoscoliosis,
❚ severe scoliosis,
❚ severe kyphosis,
❚ emphysema,
❚ allergies, and
❚ asthma.
Disorders of the respiratory system profoundly affect
aquatic activity because they limit the amount of
air coming into the lungs and therefore decrease
cardiorespiratory endurance and muscle work due
to lack of oxygen. A respiratory disorder may pres-
ent itself as a variety of issues, including narrowing
of the bronchial tubes, increased mucous secretion,
and destruction of lung elasticity. These may result in
decreased chest expansion, decreased vital capacity,
uncoordinated breathing patterns, labored breathing,
difficulty with exhalation, nonfunctional coughing,
and poor respiratory control for speech (Charness,
1983). Medication may control symptoms but will
not cure the disorder. “Swimming traditionally has
been the sport of choice because it seems to interrupt
homeostasis less than activities that cause perspiration
and require breathing dry, cold, or pollen-laden air”
(Sherrill, 1993a, p. 483).
Teaching Tips
• Teach and encourage the double-arm back-
stroke, elementary backstroke, and inverted
breaststroke to stretch chest muscles and
expand the chest area.
• Encourage participants to move gradually from
shallow water to chest- and neck-deep water.
• Focus on activities that encourage trunk mobil-
ity to help increase vital lung capacity.
• Encourage individuals with respiratory prob-
lems to bring plastic water bottles and drink
plenty of water during swim class.
• Warm water (greater than 93 °F, or 33.9 °C)
helps spastic intercostal muscles relax, which
Specific Needs of Adapted Aquatics Participants 219
improves the individual’s capacity to expand
the chest.
• Use breath control activities, such as bobbing
and rhythmic breathing, which are good for
increasing exhalation. Remind participant to
breathe deeply and slowly.
• Use caution with high-stress, competitive,
intense activity combined with high emotional
states and fatigue. This activity may provoke
an asthma episode in some individuals with
asthma. Limit competition within the instruc-
tional program.
• Provide rests commensurate with an individual’s
needs during activity.
• Provide low-intensity activity over a longer
duration, which usually yields fewer breathing
problems.
• Use a long, slow warm-up of 15 to 30 min-
utes.
• Keep locker or changing area as clean as possi-
ble since many people with breathing problems
are sensitive to dust, mold, and even strongly
scented cleaning products.
• Avoid extreme changes in temperature. Main-
tain approximately a 4 °F (2.2 °C) difference
between air temperature in the locker room
or natatorium and water temperature in the
pool.
• Provide a place to expel coughed-up mucous.
Safety Issues
• Ensure that you understand the effects of medi-
cation on the individual’s physical and mental
performance, including the effects on heart rate
and blood pressure.
• Communicate effectively with participant and
physician to gather information concerning
medication needs and safe intensities and dura-
tions of activity.
• Be aware that for children with cystic fibrosis,
excessive loss of sodium chloride in perspiration
is dangerous. Monitor strenuous activity and use
caution during high-intensity workouts in very
warm water (greater than approximately 86 °F,
or 30.0 °C), in which participants will sweat.
• Receive instruction from parents or the physi-
cian on how to dislodge mucous plugs during
activity, in individuals with cystic fibrosis.
• Be aware that chronically ventilator-dependent
individuals can use the pool as a means of
220 Adapted Aquatics Programming
therapy and enjoyment, but the participant’s
condition may require full emergency equip-
ment and, possibly, the combined services of
a doctor, nurse, anesthetist, physical therapist,
swim instructor, and parent or caregiver (Carter,
1988). The participant may need to be hand-
ventilated or use a heavy, grounded electrical
cord and backup preparations in case of power
outages (Carter, Dolan, & LeConey, 1994). The
participant will need calm water free of splash-
ing, and the area where the ventilator is inserted
(neck for tracheostomy and nose for nasal endo-
tracheal tube) should remain above water.
Goals to Target
Individuals with respiratory problems should per-
form activities to improve rhythmic breathing by
incorporating slow, deep breathing; increase time
spent in activity; improve self-monitoring of warm-
up and exercise time within limitations; improve or
maintain chest and trunk flexibility; improve strength
in diaphragm, chest, back, and neck to help muscles
involved in breathing; and improve relaxation during
activities.
Seizure Disorders
Common Related Conditions
Seizures occur with higher incidence in people
with
❚ epilepsy,
❚ severe intellectual disability,
❚ cerebral palsy,
❚ autism,
❚ multiple disabilities,
❚ DiGeorge syndrome,
❚ developmental disabilities, or
❚ traumatic brain injury.
Seizures are manifestations of a central nervous
system disorder that upsets electrical activity in the
cerebrum. This upset causes abnormal, involuntary,
and unpredictable brain behavior ranging from focal
seizures, which are localized in one part of the brain
and cause short-term behavior changes or jerking
of the limbs, to generalized seizures, which range
from unconsciousness and total-body convulsions to
limited impairment of consciousness (semiconscious-
ness). You may observe a participant who appears to
be daydreaming, disoriented, or not paying attention
during swim instruction or you may see a participant
who suddenly drops underwater or convulses—all
these behaviors may signify that the participant is
having a seizure.
Symptoms of a seizure vary according to the type
of seizure. Minor seizures may be characterized by
staring off into space for several seconds followed
by a quick return to full alertness. More intense sei-
zures may include a combination of symptoms. The
individual may experience a strange sensation that
lasts a few seconds before the seizure. The individual
may have visual or auditory hallucinations, experi-
ence a painful sensation, or perceive a peculiar taste
or smell. The person may also suddenly become
rigid. Loss of consciousness is possible. Uncontrol-
lable muscular movement and accompanying loss of
bladder and bowel control may result. Holding the
breath, salivation, and rapid pulse are also common
during a seizure. Since many individuals with cogni-
tive impairments are prone to seizures, they will most
likely not communicate pre-seizure feelings to the
instructor due to lack of understanding of the symp-
toms. Lip smacking, holding the stomach or head, or
behavior unusual for the participant are some likely
signs a seizure event is about to begin.
Teaching Tips
• Contact a physician and refer to the Physicians’
Desk Reference (Sifton, 2006) for information
regarding the side effects of anti-seizure medi-
cation.
• Adapt activities to accommodate possible side
effects of medication such as reduced coordi-
nation and concentration, slow reaction time,
blurred vision, and increased sleepiness and
irritability.
Safety Issues
• Obtain medical clearance, including contrain-
dicated activities.
• Be aware that certain factors may provoke the
onset of a seizure, such as hyperventilation,
emotional stress, a menstrual period, excessive
caffeine, strobe lights, and illness.
• Devise a plan of action for clearing the pool
and for seizure management (not restraining
convulsions, not putting anything in the mouth,
and knowing when to call EMS; see also Seizure
Management on page 152 in chapter 7). Fill
out the appropriate incident report following
the seizure.

• Maintain close supervision during aquatic
activities, especially when in deep or open
water.
• Exercise caution for using the diving board,
including having an aide walk with the partici-
pant, if necessary.
• Discourage people from holding their breath for
as long as they can, as well as from hyperventi-
lating before underwater swimming.
• Discuss scuba diving with the participant and
obtain physician clearance before attempting
deep dives.
• Monitor drinking of pool water, as hyperhydra-
tion and hyponatremia are known to induce
seizures.
• Monitor heat tolerance, as hyperthermia is
known to induce seizures.
• Report any sudden changes in behavior to
caregivers.
• Use caution in highly competitive, extended,
or emotional activities.
• Encourage participant to wear sunglasses or
tinted goggles in outdoor pools if looking into
the sun is a seizure inducer in that person.
• Use the buddy system to provide an extra layer
of safety lookout.
• Be aware that some seizure medications
increase photosensitivity. When providing
aquatics programs outdoors, swim in early
evening or have the participant use sunscreen
or wear a fitted T-shirt.
Goals to Target
Individuals with seizures should improve indepen-
dent swimming, increase self-esteem, and improve
awareness of conditions and activities that may pre-
cipitate a seizure in the aquatic environment.
Tactile System Disorder
Common Related Conditions
Tactile disorders are commonly seen in individuals
with
❚ severe learning disabilities,
❚ pervasive developmental disabilities such as
autism and Asperger’s syndrome,
❚ prenatal exposure to drugs, or
❚ intellectual disability.
Specific Needs of Adapted Aquatics Participants 221
Individuals who experience disturbances in tactile
input or integration may have several problems in an
aquatics program. People who are hyperresponsive
to tactile information may experience problems with
the elastic parts of bathing suits touching the skin,
the feeling of a towel on the body, the sensation of
water all over the body, or the feel of the instructor’s
hands as he guides the person. Individuals who are
hyporesponsive to tactile information generally crave
tactile stimulation and need to feel and touch or chew
and taste everything.
Teaching Tips
• Find out how intensely you should touch an
individual, because some individuals respond
better to light touch and pressure while others
need heavy touch.
• Consult an occupational therapist if an individ-
ual who is hyperresponsive to touch becomes
irritable or uncomfortable with touch (tactile
defensive). Sometimes the occupational thera-
pist or other practitioner prescribes aquatics for
such an individual because the overall pressure
of water on the body helps the individual adjust
to normal levels of touching.
• Slowly introduce activities such as washing with
sponges and washcloths, swimming underwater,
playing games that require body contact with
another person, and feeling the water coming
out of the jets (see figure 9.13).
Photo courtesy of Monica Lepore
Figure 9.13  Washing with sponges helps to stimulate
the tactile system.
222 Adapted Aquatics Programming
Goals to Target
Individuals with tactile problems need to increase
tolerance to tactile input and decrease resistance to
others touching them.
Temperature Regulation
Disorder
Common Related Conditions
Temperature regulation disorders are commonly
seen in individuals with
❚ spinal cord injury above T8,
❚ traumatic brain injury, or
❚ multiple sclerosis.
Temperature regulation disorders may result from
impaired sympathetic nervous system flow, “inad-
equate secretion by sweat glands, or inappropriate
distribution of blood due to impaired cardiovascular
system control” (Glaser, Janseen, Suryaprasad, Gupta,
& Mathews, 1996, p. 7). The autonomic nervous
system impaired by spinal cord injury causes prob-
lems with vasoconstriction and vasodilation. This
results in the inability to control core body tempera-
ture effectively. The body takes on the temperature of
the outside environment, and therefore hypothermia
or hyperthermia may result if the susceptible person
becomes cold or overheated (Rogers, 1996). High
humidity, extreme heat, high-intensity exercise, and
clothing inappropriate for the environmental tem-
perature can lead to hyperthermia because the body
cannot release enough heat. Conversely, impaired
cardiovascular control and the inability to shiver due
to muscle paralysis can lead to hypothermia because
excessive heat is lost in the cold.
Teaching Tips
• Allow the individual to wear a neoprene vest or
wet suit to keep warm in cooler pools.
• Encourage the use of cool-water spray bottles to
mist the head, neck, and face in outdoor pools
or other locations where the temperature is
hot. Other ideas include providing shade and
bringing plastic water bottles to the pool and
drinking water during class in hot and humid
environments.
• Put towels in the sauna or clothes dryer so that
they are warm as the participant comes out of
the pool if the air temperature is lower than the
water temperature. Always have someone check
the towels to make sure they are not too hot to
burn the participant.
Safety Issues
• Minimize exposure to overheating and over-
cooling.
• Watch for signs of heat-related illness such
as headache, nausea, dizziness, weakness, or
exhaustion or of cold-related illness such as
blue lips and disorientation.
• Offer warm drinks after swimming in cooler
water (less than 82 °F, or 27.8 °C).
Goals to Target
Individuals with temperature regulation disorders
should become aware of situations that lead to over-
exposure and increase their awareness of the effects
of cold or hot conditions on themselves.
Vestibular System Disorder
Common Related Conditions
Vestibular system disorders are commonly seen in
individuals with
❚ cerebral palsy,
❚ traumatic brain injury,
❚ fragile X syndrome,
❚ history of stroke,
❚ severe learning disabilities, or
❚ inner ear damage.
The vestibular system provides information about bal-
ance, spatial awareness, and body position. Where a
person’s head is located in space affects what sensory
information enters the vestibular system. The semicir-
cular canals in the inner ear respond to head position
and interpret if we are off balance. Information from
the eyes also helps the brain interpret balance infor-
mation at the same time that the vestibular system
coordinates proper alignment of body parts, balance,
equilibrium, and body posture. Deficits in input and
interpretation of vestibular information result in poor
balance (ataxia) while walking, using the ladder,
recovering to vertical from lying on the front or back,
and centering on floats, kickboards, or tubes. These
deficits also cause difficulty in controlling the body’s
adjustments to gravity.

Teaching Tips
• Provide opportunities for the participant to use
a floating mat for practicing various balance
positions. Keep the mat away from the sides of
the pool while the individual is balancing on
it. Make sure the water is deep enough so that
if the individual falls off the mat, he will not hit
the pool bottom (see figure 9.14).
• Provide activities such as underwater log rolls,
somersaults, swinging, and twirling that put
the person slightly off balance so that she can
practice recovery. Provide a spotter.
• Encourage the participant to jump up and down
or side to side over the lines on the bottom of
the pool to help with balance and postural
orientation.
• Use water activities in which the participant
must straddle long, foam tubes (noodles) to
practice balance. Once the participant can bal-
ance on a tube at rest, create turbulence or pull
the tube around the pool with the individual
astride it to practice balance.
Safety Issues
• Provide assistance when people with balance
problems are on deck.
Figure 9.14  A floating gym mat can facilitate balance and having fun.
Specific Needs of Adapted Aquatics Participants 223
• Encourage participants to wear aqua shoes
while on a slippery deck or when doing quick
movements such as those in water aerobics.
• Use spotters for individuals with vestibular
system problems who are using the diving board
or jumping in the pool from the side.
• Recognize that recovery from a prone or supine
position to a vertical position may be difficult for
people with vestibular disorders. The inability
to get into a vertical position from a horizontal
position may lead to near-drowning incidents.
Goals to Target
Individuals with vestibular problems should perform
activities to increase their ability to recover to the
vertical position from prone and supine floats and to
improve their balance while walking or using flota-
tion devices.
Visual Impairment
Common Related Conditions
Disabilities commonly associated with visual impair-
ment include
❚ congenital blindness,
224 Adapted Aquatics Programming

❚ acquired blindness, away, staying directly in front of the person’s

❚ glaucoma, central vision.
❚ Leber’s anomaly, • Demonstrate in peripheral vision for a partici-
❚ retinitis pigmentosa, pant with a loss of central vision.
❚ optic nerve disease, • Provide hand-over-hand learning, or allow the
❚ retinopathy of prematurity, swimmer to place his hands on you to feel the
motions of a skill. Use sensitivity to issues of
❚ retinoblastoma,
touching and provide appropriate substitutions
❚ albinism, for the instructor, such as parent or caregiver
❚ diabetes, models (see figure 9.15).
❚ myopia, • Keep directions concise and accurate and pro-
❚ nystagmus, vide specific cues as to where to go and what to
❚ early stages of multiple sclerosis, and do. Use directions that make use of a clock face,
❚ prenatal exposure to drugs. such as, “Swim seven strokes to 12 o’clock.”
Use the terms left and right and say the number
Visual impairment is a term encompassing the of strokes or steps to be taken.
whole range of disabilities that affect sight,
from problems with distance and peripheral
vision to color blindness and double vision.
Although visual perception problems may
be considered a visual impairment, in this
section we focus on visual acuity problems,
while we discuss visual perception deficits
in the next section. Several terms describe
an individual’s degree of sight and visual
acuity. Total blindness and legal blindness are
two of the more frequently used terms. Total
blindness refers to individuals who cannot
see light, forms, or shapes. These individu-
als learn through kinesthetic experiences,
listening, and braille. Individuals with legal
blindness have some usable vision (20/200
or worse in the better eye with correction
or a field of vision of less than 20°). These
individuals can see bright objects, shapes,
and figures that have a distinct outline and
are within their sight range.

Teaching Tips
• Adapt visual demonstrations by pro-
viding tactile demonstrations with
detailed directions. Encourage indi-
viduals who are not totally blind (those
with residual vision) to make full use
of the vision they have. Wear a black
Lycra shirt or running tights to draw
attention to your leg or arm actions
underwater.
• If tunnel vision (poor or no peripheral
vision) is a problem, demonstrate no Figure 9.15  Physically moving a swimmer through a skill provides
more than 5 to 7 feet (1.5-2.1 meters) kinesthetic and tactile cues.

• Avoid using gestures, such as pointing.
• Offer a running commentary to describe what
others are doing and use names frequently.
• Use lane lines during lap swims and stroke
practice to provide tactile cues for staying in
a lane.
• Use auditory signals for direction orientation,
such as a radio playing near the deep end (if
it can be heard over the noise of a typical
pool).
• Place a water sprinkler attached to a hose near
the end of the pool to signal that the swimmer
is nearing the end during lap swim.
• Use a tennis ball impaled on a long folding
cane or use a foam noodle to tap the head or
shoulder of a lap swimmer to warn her that she
is nearing the pool end.
• Put raised tape (the kind used for sealing win-
dows and doors) on the wall of the pool at the
height corresponding to the water depth next
to it. Also, put raised numbers on the wall next
to the corresponding depth so that individuals
can trail down the wall, feel the appropriate
height independently, and get in at the depth
they want to.
• Have a participant bring a magnet to stick onto
her locker so she can find it independently if
braille is not available. Remove the magnet
when finished.
• Use the sighted guide technique for mobility.
• Provide orientation to the pool and its environ-
ment with a sighted guide. This will help the
swimmer organize and plan pool entries and
exits.
Safety Issues
• Provide participants with an extra safety lookout
to give verbal feedback in case of disorienta-
tion.
• Communicate effectively with the participant
to avoid hazards in the environment.
• Be aware that individuals with partial retinal
detachment must avoid bumping the head or
eyes. You may need a somewhat segregated
environment, using a sighted spotter to inter-
cept balls, kickboards, and other people from
bumping into the swimmer.
• Have sighted spotters provide cues for individu-
als who want to jump or dive.
Specific Needs of Adapted Aquatics Participants 225
Goals to Target
Individuals who are blind or visually impaired should
perform activities to improve overall fitness, fluidity of
movement (to address their tendency to have rigid pos-
ture and mobility), posture (shoulders and head aligned
with trunk), mobility, orientation, independence, body
image, spatial awareness, and sound localization.
Visual Perception Disorder
Common Related Conditions
Visual perception deficits are common in individu-
als with
❚ history of stroke,
❚ traumatic brain injury,
❚ multiple sclerosis,
❚ cerebral palsy,
❚ learning disabilities,
❚ severe intellectual disability, or
❚ prenatal exposure to drugs.
Visual perception problems may be due to a difficulty
with eye coordination or to an inaccurate interpre-
tation of speed, size, distance, and location. Visual
perception deficits relate to judging and interpreting
what the eye sees, including components such as
figure–ground discrimination (locating an object
against a background), tracking across the midline
and up and down (following an object from one point
to another), seeing the whole picture, depth percep-
tion, binocular vision, and eye–hand and eye–foot
coordination. These types of problems reduce visual
efficiency and interpretation of the environment,
causing motor output of poor quality.
Teaching Tips
• Place a brightly colored or black bath mat on
the bottom of neck-deep water where the par-
ticipant will be jumping in to help with depth
perception.
• Use brightly colored equipment.
• Decrease extraneous visual stimuli, such as
wearing a tie-dyed bathing suit or having several
people located behind you as you perform a
demonstration.
• Have the participant practice swimming under
lane lines, through hoops, and between people
(see figure 9.16).
226 Adapted Aquatics Programming
Figure 9.16  Swimming through a hoop is a visual perception activity.
• Manipulate body parts physically to offer kin-
esthetic instead of visual input.
• Use key cue words, such as “elbow high,” to
give a mental picture of the task.
• Hold a darkly colored or black jump rope
at various heights under shallow water and
encourage the participant to step, leap, hop,
and jump over it.
• Wear a black, solid-colored bathing suit and,
if needed, black, solid-colored Lycra tights and
shirt to draw attention to your limb actions
during demonstrations.
• Encourage the swimmer to move around, feel,
and generally experience the entire pool area
to help with interpretation of visual informa-
tion.
Safety Issues
• Be aware that due to problems with depth per-
ception, individuals may misjudge the depth
of water, not recognizing it is too shallow or
too deep.
• Put brightly colored tape or paint on edges of
steps.
• Guide foot placement when walking in the pool
by using your feet to help guide the participant’s
feet.
• Provide “No Jumping” and “No Diving” signs
and verbal reminders.
• Provide spotters for pool entries and exits as
tripping on stairs and ladders may be a problem
due to overstepping or understepping.
• Keep in mind that because visual perception is
involved in knowing how far a person is away
from other objects, deficits in this area can result
in bumping into others, equipment, or walls and
in throwing balls too hard.
Goals to Target
Individuals with visual perception problems should
perform activities to improve lap swimming without
bumping into lane lines or others, increase accuracy
of imitation of visual demonstrations, improve abili-
ties to use ladder and stairs safely, improve ability to
distinguish depths, and improve ability to differentiate
among sizes, shapes, and colors of pool equipment.
Summary
Each individual that you encounter in aquatics will
be a unique person with unique characteristics. Refer
to this chapter to better understand the multitude of
characteristics and disabilities that individuals may
have and the kinds of attributes these disabilities
may involve. Use table 9.1, along with the sections
on teaching tips, safety issues, and goals to target for
the specific challenges you face, to help meet the
individual needs of swimmers with disabilities in a
safe, successful, and satisfying manner.
 Specific Needs of Adapted Aquatics Participants 227

Chapter 9
Review 1. Explain labeling and how it may negatively affect an individual.
2. What aquatic activities should be avoided by a participant with AAIS?
3. Identify some characteristics for which it is helpful to give a physical
prompt. What unique attributes might cause a physical prompt to be a
poor choice?
4. How may a disturbance in the respiratory system impair performance in
aquatics?
5. What are contractures? How do they impair swimming performance?
6. List several hints for working with individuals who have problems under-
standing directions.
7. How does legal blindness differ from visual perception disorder?
This page intentionally left blank.
 10
Aquatic Fitness and
Rehabilitation

J   amie is a 35-year-old female with spastic cerebral palsy. Fifteen years ago,
while a sophomore at Wright State University (WSU), she became involved
in the adapted aquatics program. During her initial interview with the adapted
aquatics instructor, she revealed her fear of the water due to a previous aquatics
experience that occurred much earlier in her life and that involved low instructor
expectations and poor pedagogy techniques.
Jamie and her instructor set two lifelong goals. They agreed that when she
graduated from WSU, she would be an independent swimmer and she would
possess the knowledge and courage to access a pool regardless of where she
lived.
Jamie and her instructor broke down her broad goals into smaller objective
components. The initial objectives centered on the instructor building credibility
and Jamie building her confidence. Jamie agreed to (a) regularly attend the
adapted aquatics sessions, (b) sit on the pool deck with her feet in the water, (c)
converse with other participants, and (d) watch the instructor work with other
participants. The instructor desired for Jamie to take control of her own decision
making and engineered rest periods for the students, allowing Jamie to confi-
dentially converse with them. After several visits Jamie decided to enter the pool,
exercise, and socially interact. She continued to exercise and dedicate herself to
becoming an independent swimmer regardless of where she lived.
(continued)

229
230 Adapted Aquatics Programming
Today, she is a counselor for the Ohio Department of Vocational Rehabilitation,
lives independently, participates in water aerobics, and swims at a community
recreation facility. Such independence and knowledge of skills and health-related
physical fitness enable her to maintain an independent and active lifestyle.
T raditionally, society has often perceived individu-
als with disabilities as unhealthy, although the
World Health Organization (WHO) defines health
as “a state of complete physical, mental, and social
well-being and not merely the absence of disease
or infirmity” (World Health Organization [WHO],
1946, p. 2). In 2004, the WHO Family of International
Classifications (WHO-FIC) added a new member,
called the International Classification of Function-
ing, Disability, and Health (ICF). The ICF framework
shifts the focus from mortality to life. It describes how
people live with their health conditions, taking into
account the social aspects of disability and document-
ing the effect that the social and physical environ-
ments have on a person’s functioning (WHO, 2004).
While health promotion is increasingly thought of
as empowering people to increase their control over
their health, prerequisites for successful control of
their lives include individual participation and sup-
portive environments. Rimmer (1999) redirects and
comprehensively expands the discourse on health
from disability prevention to prevention of secondary
conditions (e.g., obesity, pressure sores), maintaining
functional independence, providing opportunities for
leisure, and enhancing overall quality of life by reduc-
ing environmental barriers to good health (National
Center on Physical Activity and Disability [NCPAD],
2004; Rimmer, Riley, Wang, Rauworth, & Jurowski,
2004). Therefore, when considering a person’s health,
psychological well-being as well as physical health
must be acknowledged.
Wellness is an approach to personal health that
emphasizes the individual’s responsibility for well-
being through the practice of health-promoting life-
style behaviors (Nieman, 2003). Aquatics can provide
rehabilitation and fitness training for individuals with
or without acute or chronic disorders. It is critical to
alter traditional attitudes of aquatics leadership, staff,
participants without disabilities, and other patrons to
accept, include, and learn about individuals with dis-
abilities. Furthermore, as we have discussed through-
out this book, aquatics instructors must adapt exercise
techniques, equipment, and social and environmental
factors to encourage people with disabilities to make
necessary lifestyle changes, thereby ensuring long-
term success. Physical fitness is more than one aspect
of wellness; it can act as a catalyst to improve the
other aspects of wellness, including mental, social,
emotional, and spiritual well-being.
This chapter introduces health-related physical fit-
ness and relates it to aquatics. In this chapter we offer
tips for dealing with various disabilities and circum-
stances you may encounter in striving to increase the
fitness of participants with disabilities. Then we offer
tips and address contraindications related to aquatic
rehabilitation. You should not substitute reading this
chapter for formal training in rehabilitation. Instead,
use this chapter both as a basic guide to appropri-
ate practices and as a springboard for further study.
Contact the aquatic fitness organizations listed in
appendix E for course and certification information
that will enhance your professional knowledge of
health-related physical fitness.
Chapter Objectives
From this chapter, you will learn the
following:
* The WHO defines health as physical,
mental, and social well-being, not just
the absence of a disability.
* Health contains both skill and physical
fitness components.
* Assisting aquatics participants in defining
personal goals is an important initial step
toward increasing their control over their
own health.
* There is a variety of exercise equipment
available to enhance participation,
including water shoes, Wet Vests, full-
body flotation devices, swimsuits with
built-in flotation bladders, and foam flo-
tation bladders.
* The principles of enhancing cardiorespi-
ratory fitness through water aerobics are
frequency, intensity, time, and type of
exercise.

* Alternative methods of monitoring exer-
cise intensity include the Borg scales of
perceived exertion and the “talk test.”
* Body alignment and posture contribute
to a participant’s feeling of well-being.
Health-Related Physical
Fitness and Aquatic Exercise
Physical fitness is generally accepted as the ability to
carry out daily tasks with vigor and alertness, with-
out fatigue, and with ample energy to enjoy leisure
pursuits and to meet unforeseen emergencies (U.S.
Department of Health and Human Services, 1996).
The most frequently cited measures of physical fit-
ness fall into two groups: measures related to health
and measures related to athletic skills. Skill-related
physical fitness is important for participating in
various individual and team sports. It includes agil-
ity, balance, coordination, power, reaction time, and
speed. These skill-related components are defined
as follows:
• Agility—The ability to change the position
of the entire body in space with speed and
accuracy.
• Balance—The ability to maintain equilibrium
while stationary or moving.
• Coordination—The use of the senses, such as
seeing and hearing, together with other body
parts to perform motor tasks smoothly and
accurately.
• Power—The rate at which a person can perform
physical activity.
• Reaction time—The time elapsed between
stimulation and the beginning of the resulting
reaction.
• Speed—The ability to perform a movement
within a short time (Corbin & Lindsey, 1994).
Health-related physical fitness refers to a person’s
ability to work effectively, enjoy leisure time, resist
hypokinetic diseases, and meet emergency situations
(Corbin & Lindsey, 1994). It includes body composi-
tion, cardiorespiratory endurance, flexibility, mus-
cular endurance, and strength. These health-related
components are defined as follows:
• Body composition—The relative amounts of
muscle, fat, bone, and other vital parts of the
human body.
Aquatic Fitness and Rehabilitation 231
• Cardiorespiratory endurance—The ability of the
circulatory and respiratory systems to supply
oxygen during sustained physical activity.
• Flexibility—The range of motion (ROM) avail-
able at a joint.
• Muscular endurance—The ability of the muscle
to continue to perform without fatigue.
• Muscular strength—The ability of the muscle to
exert force (Corbin & Lindsey, 1994).
The trend today in the United States is to empha-
size the development of health-related fitness ele-
ments and to push for their prominence in school,
work, and community programs (Nieman, 2003).
Since cardiorespiratory endurance is considered one
of the primary components of health-related fitness
and swimming works large muscle groups for an
extended time, the obvious conclusion is that swim-
ming is one of the best avenues for regular exercise
leading to health-related physical fitness.
Aquatic exercise has become a popular activity
that meets the needs of a culturally diverse society.
The focus of aquatic exercise tends to be on physical
fitness, independence, and mobility. Walking, jogging
(in both shallow and deep waters), aerobics performed
to music, sport-specific workouts, step aerobics, tai
chi, and circuit training are only a few examples of
aquatic activities used to enhance physical fitness.
Help participants choose a program or combination
of programs based on interest, physical ability, and
program availability. To integrate individuals with
disabilities into an aquatics program, find an aquatic
exercise instructor (AEI) with a good attitude toward
inclusion, make sure participants can regain their
footing in the pool as needed, or provide a support
person to help them in the water at all times.
To design a safe and sound water exercise program,
you should have a professional fitness or physical
education background or be certified by the AEA,
USWFA, AAHPERD, or other national agency. You
should also have the training that was discussed in
chapter 1, and you should continue your education
by reading articles, attending courses and confer-
ences, and watching other instructors in order to
stay abreast of current safety, technological, and
educational advances.
Who uses aquatic exercise programs? Teens and
adults, individuals with disabilities, athletes with
and without sport injuries, and older people, among
others, participate in aquatic exercise. Individuals with
chronic medical disorders, such as arthritis, coronary
heart disease, or multiple sclerosis, use aquatic
exercise as a rehabilitation tool to return to their
former activity levels. Kinesiotherapists, occupational
232 Adapted Aquatics Programming
therapists, and physical therapists often use aquatic
exercise as a work-conditioning tool to help injured
individuals build the strength and endurance that they
need to reenter the working world. Other people who
participate in prescribed aquatic exercise include
individuals who are obese, who are pregnant, or
who have recently had surgery. Although water has
been used for therapeutic purposes for centuries,
only recently has it been widely utilized in the
rehabilitation community. Therefore, the issue of who
is qualified to provide these services continues to be a
dynamic concern. Aquatic therapy can be defined as
using an aquatic medium to achieve physical therapy
goals, and therapeutic exercises are those activities
that are prescribed by a doctor, a physical therapist,
or an occupational therapist (Hall & Brody, 1999;
Katz, 1996).
Participation Factors and
Challenges
Obstacles may confront a person with disabilities
who is trying to achieve physical fitness. Physi-
ological and psychological obstacles include fear of
water, seizures, cardiac dysfunction, open wounds,
tracheotomies, and intravenous lines (Kisner & Colby,
2003). Examine the issues addressed in the follow-
ing sections before helping a participant set goals
and objectives and embark on a regimen to improve
physical fitness.
Present, Preaccident, or Presurgery
Fitness Status
If the person was active and involved in fitness
activities before the injury or surgery, there is a good
chance that she will want to use activity as a means
of rehabilitation. If a person with long-term disabili-
ties is presently active, he also will be more likely to
seek aquatic fitness. Individuals with a higher fitness
level are often more motivated to perform the fitness
routines.
Present, Preaccident, or Presurgery
Swimming Abilities
While the risks of aquatic exercise are minimal,
participants with no previous swimming ability may
feel anxiety, apprehension, and fear about beginning
a fitness program in water. Fear of the water may limit
the effectiveness of aquatic exercise programs and
even elevate negative symptoms. Orienting the par-
ticipant to movement in water, including the effects of
immersion on balance; to the use of flotation devices;
and to walking, jogging, and other water exercises
may be the only way to initially expose him to the
aquatic environment. The most prominent secondary
risk of aquatic exercising is overdoing activity due to
the water’s effect on buoyancy (Norton & Jamison,
2000). A thorough initial orientation and limited ini-
tial activity will help a participant swim sooner rather
than later. Remember, a healthy mixture of knowledge
and common sense will make you a skilled aquat-
ics instructor. You should positively reinforce all
swimmers, constantly pointing out all achievements.
People who were swimmers before experiencing
an accident may not experience fear but may have
unrealistic expectations as to what they can now
perform. Often, participants who were competitive
swimmers or divers may become frustrated as they
recognize that they may never return to their previous
skill levels. You may use the following approaches to
encourage such an individual:
• Assist the participant in defining achievable
personal goals.
• Reinforce goals by emphasizing that progress
is made in small steps (in meeting personal
objectives).
• Initiate support for the individual through one-
on-one or peer tutoring.
• Incorporate socialization into the sessions.
• Encourage the development of new interper-
sonal relations.
• Reduce stress, isolation, and depression.
• Enhance quality of sleep.
• Help the participant realize that no one is star-
ing at her.
• Convince the individual that if other people
have a problem with her skills, it is the other
person’s problem, not hers.
• Allow alternative swimwear (e.g., a T-shirt and
long shorts) for someone who has body image
issues perhaps due to obesity, surgical scars, or
atypical or missing extremities.
Duration of Sedentary Life
Strength and endurance are problems for anyone who
has been on prolonged bed rest. Question participants
as to whether they have recently spent a long time
in a horizontal position, perhaps during hospitaliza-
tion. When working with someone who is severely
deconditioned due to prolonged inactivity, start very
slowly and monitor progress carefully.
You cannot be too cautious. Each participant
should turn in a medical form in which his physi-
cian identifies risks in or any contraindications to
physical activities. In addition, the participant should

sign an informed consent form, which describes the
program and its potential risks and thus clarifies any
assumptions that the participant may have toward
injury risk. Monitor pulse and blood pressure, at least
initially. Participants who spend most of their time
in a horizontal or reclining position may develop
orthostatic hypotension when you ask them to stand
or hold themselves in a vertical position in the pool.
An extreme drop in blood pressure caused by moving
into a vertical position may cause such participants
to lose consciousness. Again, ask participants if they
have been recently confined to a horizontal position
for an extended duration.
You should also take precautions with people who
are on certain medications. Seizure medications, for
example, may cause side effects that interfere with
target heart rates. Furthermore, excitement, frustra-
tion, strobe lights, hypoglycemia, hypoxia, menstrual
cycle changes, and hyperventilation before swimming
underwater can all precipitate a seizure (Durstine &
Moore, 2003). Monitor locker-room activities as well
as pool activities. Insist that a person who is fatigued
rest before attempting to go home. See chapters 7 and
9 for more information on managing seizures.
The following are tips for developing exercise ses-
sions for people with a tendency to fatigue:
• Have the swimmer walk or begin by swimming
pool widths rather than lengths.
Figure 10.1  You can make fitness activities more appropriate by monitoring pulse.
Aquatic Fitness and Rehabilitation 233
• Divide the length of the pool into thirds using
buoys and lane lines, and have the swimmer
rest at each division until she has more endur-
ance.
• Set realistic goals and objectives and avoid
pushing the swimmer before he is ready.
• Monitor pulse (see figure 10.1).
• Stay alert for signs of fatigue, such as falling,
sloppy swim strokes, irritability, and exagger-
ated motor and cognitive deficits.
• Call the swimmer the next day to determine if
she was too tired following the session.
Physical Abilities
As discussed in chapters 3 and 4, a participant’s
abilities can be learned through assessment, inter-
viewing, and reading medical charts or forms. As
an AEI, develop a swim program for the participant.
Excessive muscle tone, paralysis, postsurgical status,
hydrostatic water pressure, behavior problems, and
balance problems can limit the aquatic activities
that a participant can perform to improve fitness.
Some typical fitness activities, such as unassisted lap
swimming, treading water, and walking laps, may not
be viable options for people with certain types of
physical disabilities. Flotation devices and stationary
objects such as tot docks and chairs, however, can
assist people with balance problems in developing
234 Adapted Aquatics Programming

other components of skill-related fitness, such as Understanding of Fitness Concepts

agility. Still, the less assistance that you provide, the
more intensely the participant will be able to perform
rhythmic aerobic exercises in water, and therefore
the more she will be able to improve fitness. Offer
the least amount of assistance that you can while
still ensuring that the activity is safe and enjoyable
for the individual.
Carefully watch people with hemiplegia, paraple-
gia, quadriplegia, or incomplete muscular paralysis
and follow these hints for providing exercise programs
for them:
• Be alert to pain and inflammation and to how
the body parts with impaired sensation and
movement respond to exercise. Protect these
vulnerable areas with cotton gloves, socks,
shoes, and shirts, as participants can unknow-
ingly injure themselves on the pool bottom,
pool wall, or lane lines (see figure 10.2).
• Consult each individual’s occupational or
physical therapist, kinesiotherapist, or athletic
trainer as to how you might assist with ROM
exercises.
• Don’t assume that the affected body parts have
no movement; sometimes the part may have
residual movement potential.
• When designing a fitness program for persons
with weak or partial paralysis, follow the same
protocol that they follow in physical therapy:
Begin with passive ROM and then move on
to active-assistive, active, and finally resistive
exercise.
Photo courtesy of G. William Gayle
Fitness is not an easy concept to understand, espe-
cially for individuals who have cognitive impairments.
Warm-ups are a good time to explain the basics of fit-
ness, to get the person fully involved in the exercises.
If the information you need to present is too difficult
for the person to understand, pair benefits such as
feeling good and looking good with pictures of people
getting into shape through aquatic exercise.
As you explain the basics of fitness, strive to teach
the participant to view swimming and other water
exercises as lifelong activities. A participant may
continue to swim independently when she recognizes
that there are other benefits to swimming laps besides
recreation and fun. How else can you motivate an
individual? Try using the ARC Swim and Stay Fit charts
(ARC, 2004a), the Borg scales (Borg, 1998), and
homemade water-walking charts to promote fitness.
Another motivating point to include in fitness dis-
cussions is the value of fitness in life outside the pool.
Some participants may want to swim when they learn
that it helps them gain and maintain the strength and
endurance needed to transfer into and out of their
wheelchairs or beds. Others may see swimming as
a social outlet.
Equipment and Expertise Available
Lack of equipment should not eliminate a fitness
class. As long as participants can enter, maneuver,
and exit the pool safely, you can begin your program.
You can purchase or make various pieces of equip-
ment to make sessions more interesting, but such
items aren’t required. The Wet Vest (see figure 10.3),

Photo courtesy of Monica Lepore

Figure 10.2  Water shoes provide protection and   Figure 10.3  A Wet Vest provides support for vertical  
traction. fitness exercise.

a jacket-type flotation device that keeps a person
vertical, and fitness paddles, plastic hand paddles
that increase resistance during upper-body exercise,
are just two pieces of equipment that can enhance
physical fitness workouts in water. See chapter 6 for
more information about equipment. Use caution
when working with certain pieces of equipment. Wet
Vests are not personal flotation devices, so you must
closely supervise nonswimmers who are using them.
In addition, it can be dangerous to allow impulsive
participants to use water weights.
Although an aquatic fitness program can begin
without equipment, it cannot function without
knowledgeable and personable personnel. To staff
your aquatic exercise program, you can have an
aquatics fitness expert develop and conduct classes,
have swimming instructors conduct classes, and
have an expert consultant come in several times
to give advice. Swimming instructors may attend
classes and conferences and read literature to
become knowledgeable enough to gain certifica-
tion as AEIs. Discuss your program plans with other
professionals, such as physical educators, therapists,
athletic trainers, and exercise physiologists, as you
strive to plan a physical fitness program that will
meet the needs of your participants. See appendix
E for resources providing general information on
aquatic fitness. Additional sources on aquatic fit-
ness, including Bishop (2002) and Sova (1992),
also appear in the reference section at the end of
this textbook.
Enhancing Cardiorespiratory
Endurance
Success in activities that require sustained rhythmic
movement depends on a good level of cardiorespi-
ratory endurance. Individuals with disabilities need
cardiorespiratory endurance to push their wheelchairs
long distances; ambulate with braces, crutches, or
walkers; perform work and home activities of daily
living; and perform manual labor. Cardiorespiratory
fitness is best obtained through aerobic exercise. The
term aerobic means in the presence of oxygen. The
ability of the heart, vascular system, and respiratory
system to move oxygenated blood to the muscles
efficiently and the ability of the muscles to use the
oxygen efficiently for an extended duration determine
the amount of endurance a participant demonstrates.
In order for cardiorespiratory training to take place
in water exercise, the activities or swim strokes must
involve the large muscles in the legs and buttocks and
must last 20 minutes while the participant works at
his target heart rate.
Aquatic Fitness and Rehabilitation 235
Frequency, Intensity, Time, and Type
You should apply general principles of fitness train-
ing to swimmers with and without disabilities. To
set goals, first discern what the participant wants
to achieve. Does she want to achieve endurance?
Strength? Any other aspect of health-related fitness?
Next, help the participant set realistic goals, and then
plan and follow a progressive, objective-based train-
ing program. While you may plan for cross-training
for strength and flexibility out of the pool, the main
component of a swimmer’s cardiorespiratory train-
ing should occur in the pool. To create a complete
and safe plan, follow these guidelines for frequency,
intensity, time, and type (FITT):
• Frequency: Frequency is the number of exercise
sessions per week, and it should be based on
the intensity and duration of the exercise ses-
sions.
• Intensity: The exercise intensity should be at
55% to 90% of maximum heart rate, depend-
ing on the participant’s current level of fitness
and goals.
• Time: The participant should spend at least 20
minutes in the target heart rate zone (THRZ)
per workout.
• Type (Mode): Many types of aquatic activities
facilitate health-related fitness. A type should
be selected based on the participant’s goals
and objectives, interests, time, facility, and fit-
ness level.
Frequency
Depending on the participant’s current level of fit-
ness and goals, sessions may be held 3 to 5 days per
week, with no more than 2 days between sessions.
Participants who are out of shape may benefit most
from multiple, short exercise sessions held throughout
the day. As fitness improves, daily exercise sessions
can be increased in length and reduced in number.
In addition to limiting initial workouts to 3 times per
week, ensure that participants have a 24-hour rest
period following maximal swim workouts in order to
avoid overtraining. Overtraining is especially a risk for
people who both swim and use manual wheelchairs;
never giving their arms, wrists, and shoulders a rest
(recovery time) can result in injury.
Intensity
Establish an intensity level to keep the exercise
pace within a range appropriate for developing and
maintaining cardiorespiratory fitness. The American
College of Sports Medicine (ACSM) recommends
keeping exercise intensity between 55% and 90%
236 Adapted Aquatics Programming
of maximum heart rate or between 40% and 85% of
heart rate reserve (HRR). Exercise intensity continues
to be the most critical factor for successful training.
The terms resting heart rate, maximum heart rate,
heart rate reserve, target heart rate, and training
heart rate are confusing for many people, especially
when participants with disabilities are considered.
A resting heart rate (RHR) is the number of times the
heart beats per minute when the body is at rest. A
maximum heart rate (MHR) is the fastest heart rate
that can be measured when an individual is brought
to total exhaustion. An individual’s MHR can be
approximated by the following formula:
MHR = 220 – age.
Even among people of the same age, MHR varies
widely, because the formula is based on Caucasian
male population averages. One standard deviation
equals ±12 beats per minute. Therefore, two thirds
of the population deviates an average of 12 beats
per minute from the average, indicating large vari-
ability (Nieman, 2003). HRR is defined as the differ-
ence between MHR and RHR (HRR = MHR – RHR)
(Wilmore & Costill, 2004). The THRZ is the heart rate
zone that a participant should attempt to stay within
during exercise.
Intensity Evaluation Methods
We have discussed exercise frequency, defined terms
associated with exercise intensity, and established that
in the aquatic environment instructors have to rely
on alternative or applied methods to monitor exercise
intensity. Let’s examine several feasible methods of
rating exercise intensity.
Monitoring Intensity by Heart Rate  There are sev-
eral formulas that will allow you to easily calculate
the THRZ. However, traditional heart rate predictions
are based on land exercise that utilizes the lower
extremities. The first and oldest method of calculating
THRZ is to use predicted MHR as follows:
THRZ lower limit = (MHR) (50%).
THRZ upper limit = (MHR) (80%).
If MHR = 180, then
THRZ lower limit = (180) (.50),
THRZ upper limit = (180) (.80), and
THRZ = 90 to 144 beats per minute.
The second method of calculating THRZ is the
HRR, or Karvonen, method (American College of
Sports Medicine [ACSM], 2000). This method finds
the difference between RHR and age-predicted MHR.
Assuming that MHR is 180 beats per minute and RHR
is 75 beats per minute, the standard Karvonen formula
can be used to calculate THRZ as follows:
THRZ lower limit = [(MHR – RHR) (50%) + RHR].
THRZ upper limit = [(MHR – RHR) (80%) + RHR].
THRZ lower limit = [(180 – 75) (.50) + 75],
THRZ upper limit = [(180 – 75) (.80) + 75], and so
THRZ = 128* to 159 beats per minute.
The * indicates that the number was rounded up.
Research continues on the metabolic responses
to horizontal and vertical exercise in water. Due to
hydrostatic pressure, thermal response, lack of gravity
(easing stress on the heart), and the dive reflex, heart
rate is usually lower for aquatic exercise. For trained
and untrained athletes, MHR when swimming is 13
beats per minute lower than MHR during running.
This difference is probably due to the smaller muscle
mass of the upper extremities (McArdle, Katch, &
Katch, 2000). In addition, participants who use the
upper body but not the legs for fitness swimming and
water exercise cannot elevate their heart rates to a
typical THRZ due to the smaller amount of muscle
mass involved. Subtracting 13 beats per minute from
the upper and lower limits of the projected THRZ
appears to account for these phenomena.
The third method of calculating THRZ includes
an adjustment for exercising in water. Compare the
following modified Karvonen formula to the standard
Karvonen formula previously discussed. Let’s use the
modified formula to calculate the THRZ for Manuel, a
40-year-old male with an RHR of 75 beats per minute
and functional impairment of the lower extremities.
Calculation of Manuel’s THRZ is as follows:
THRZ lower limit = [(MHR – RHR) (50%) + RHR] – 13 beats
per minute.
THRZ upper limit = [(MHR – RHR) (80%) + RHR] – 13 beats
per minute.
THRZ lower limit = [(180 – 75) (.50) + 75] – 13 beats per
minute,
THRZ upper limit = [(180 – 75) (.80) + 75] – 13 beats per
minute, and so
THRZ = 115* to 146 beats per minute.
The * indicates that the number was rounded up.
When estimating their MHR, participants with
spinal cord injuries should subtract 40 from 220 (220
– 40 = 180) and then subtract their age (MHR = 180
– age) (Lockette & Keyes, 1994). People with quad-
riplegia have even lower exercise heart rate zones,
with peak heart rates ranging from 100 to 125 beats
per minute (Glaser, Janseen, Suryaprasad, Gupta, &
Mathews, 1996). Medication and heart disease may
be additional confounding variables in the calculation
of THRZs for aquatic exercise.
Like exercisers with spinal cord injuries, individu-
als with progressive disabilities and neuromuscular
 Aquatic Fitness and Rehabilitation 237

disorders that induce early fatigue may also find the 6 No exertion at all
above standard or Karvonen formulas too aggressive 7
Extremely light
(Lockette & Keys, 1994). The rating of perceived 8
exertion (RPE) scale discussed next might be a more 9 Very light
reasonable method of describing the level of exer- 10
cise intensity as it relates to physical strain during 11 Light
exercise. 12
Finding and monitoring heart rate for people with 13 Somewhat hard
sensory problems of the hands (people with quadriple- 14
gia, arthritis, peripheral vascular disease, diabetes, 15 Hard (heavy)
multiple sclerosis, and so on) may be difficult (Grosse, 16
1993). Heart rate monitors may be purchased for par- 17 Very hard
ticipants to wear on the finger, wrist, arm, or chest from 18
Biosig Instruments (see appendix E). Some individuals 19 Extremely hard
may need their blood pressure monitored during and 20 Maximal exertion
after swimming or water exercise. This group includes
Figure 10.4  The Borg RPE scale.
people with spinal cord injuries who experience
Reprinted, by permission, from G. Borg, 1998, Borg’s perceived exertion and pain scales
exercise hypotension and orthostatic hypotension and Borg RPE
(Champaign, IL: Human Kinetics), 47.
scale
C Gunnar Borg, 1970, 1985, 1994, 1998
people with cardiovascular disease. © Gunnar Borg, 1970, 1985, 1994, 1998

Alternative Methods of Monitoring Intensity  Since

much research remains to be completed on the
metabolic responses of individuals with disabilities 0 Nothing at all "No P"
in water, one of the easiest methods of monitoring 0.3
intensity is using the Borg scales. The Borg rating of 0.5 Extremely weak Just noticeable
perceived exertion (RPE) scale (see figure 10.4) and 1 Very weak
the Borg CR10 scale (see figure 10.5) were developed 1.5
by Gunnar Borg, a Swedish professor. The Borg scales 2 Weak Light
are reliable indicators of participant exercise toler- 2.5
ance and are widely utilized in laboratory research 3 Moderate
and community exercise programs. The scales were 4
developed to allow participants to subjectively rate 5 Strong Heavy
their feelings during exercise. They provide individu- 6
als of all fitness levels with easily understood termi- 7 Very strong
nology about exercise intensity and pain, allowing 8
them to indicate pending fatigue. After receiving 9
instructions on how to use the scale, the participants 10 Extremely strong "Max P"
provide a number corresponding to their level of 11
perceived exertion or pain.
Perceived exertion is “the feeling of how heavy and Absolute maximum Highest possible
strenuous a physical task is” (Borg, 1998, p. 8). The
RPE scale is most commonly used to rate perceived Figure 10.5  The Borg CR10 scale. Borg CR10 scale
C Gunnar Borg, 1981, 1982, 1998

exertion, and reported ratings grow linearly with exer-
cise intensity, heart rate, and oxygen consumption.
The CR10 scale has fewer numbers than the RPE scale
has, and it does not demonstrate the linear relation-
ship with exercise intensity that the RPE scale does.
Borg states that “in most situations it is preferable to
use the RPE scale for perceived exertion and the CR10
scale for pain ratings” (Borg, 1998, p. 15). Given the
type of work that individuals with disabilities perform
in aquatics programs, we suggest that you use the RPE
scale. However, we encourage you to read Borg’s
explanation (1998) and review figures 10.4 and 10.5
for a comparison of both scales.
Reprinted, by permission, from G. Borg, 1998, Borg’s perceived exertion and pain scales
(Champaign, IL: Human Kinetics), 50.
© Gunnar Borg, 1970, 1985, 1994, 1998
The easiest method of monitoring exercise intensity
(while void of supportive scientific data) is referred
to as the talk test. This test is used to indicate maxi-
mal effort. If the participant cannot converse while
exercising, it is assumed that she is near peak perfor-
mance and needs all oxygen breathed in to supply
the working body. During general exercise sessions,
participants should be able to speak with others, or
their intensity level is too high.
 238 Adapted Aquatics Programming
Time
Time refers to the duration of the exercise session,
not including the warm-up or cool-down. Exercise
participants should be encouraged to spend at least 20
minutes in their THRZ per workout. Of course, indi-
viduals who are in extremely poor condition will have
to work up to this duration. Some individuals may not
be able to keep the aerobic pace going due to cardio-
vascular problems or fatigue related to their disability.
Therefore, exercise sessions for people with low fitness
can begin with as little as four to six 5-minute activity
bouts, with rests supplied between bouts. People with
quadriplegia, postpolio syndrome, multiple sclerosis,
muscular dystrophy, and progressive neuromuscular
disabilities might need to take an interval approach
to aerobic exercise, doing short bouts of exercise for
2 to 5 minutes and then resting for 1 to 2 minutes in
between (Lockette & Keyes, 1994). Individuals who
have thermoregulation disorders (due to spinal cord
injuries) or become excessively fatigued due to heat
(people with multiple sclerosis) should cool off with
frequent water breaks and take rests when needed.
The maximum length of a workout should depend
on the participant’s current condition and on reports
of excessive fatigue and soreness following workouts.
Naturally, overdoing it does more harm than good, as
injury or soreness sidelines a participant.
Type
Specific aerobic activities that achieve cardiorespira-
tory training include swimming laps, swimming while
tethered (see figure 10.6), shallow water-walking or
water-jogging, running on a water treadmill, perform-
Photo courtesy of G. William Gayle
Figure 10.6  A tether can keep a participant in close range for
providing feedback or alleviating fear.
ing water aerobics to music, deep water-jogging with
or without flotation, treading water, and playing water
polo. Base the type of activity on the individual’s
interests and capabilities as well as on the program
availability.
Warming Up
As you know, it is essential to warm up before car-
diorespiratory pool workouts. Performing full-body
exercise at a low intensity for approximately 5 min-
utes should be sufficient in most cases. Excellent
ways to warm up include swimming the elementary
backstroke, swimming with a flotation device, tread-
ing water, or walking and jogging in shallow water
(or in deep water with a flotation device), followed
by stretching exercises for the specific muscle groups
that the workout will stress.
During group water aerobics, when a participant
cannot keep up or cannot perform a specific move,
you can modify the steps in several ways:
• Have the participant perform a specific arm
action, such as pumping the arms as if run-
ning.
• Imitate the leg action with the arms (see figure
10.7).
• Move the legs with the hands.
• Lean the body in the direction the class is
moving.
• Use a tire tube or another flotation device.
• Have an assistant help the participant move.
Enhancing Flexibility:
Adaptations and Issues
Flexibility is the ability to move a joint through its
complete range of motion (ACSM, 2006, p. 85). There
are various methods of developing flexibility, includ-
ing active (static or ballistic), passive, and combined
(Norm & Hanson, 1996). Flexibility is important for
activities of daily and athletic performance.
Aquatic exercise improves ROM in joints. Poor
ROM of the shoulder, neck, elbow, wrist, hip, or
ankle can make it harder for an aquatics participant to
improve fitness, because flexibility affects the ability
to add resistance during the power phase of a swim
stroke and to recover the arms above the water.
Aquatic exercise is valuable for improving ROM
in specific populations for which ROM is limited by
disuse, disease, or disability. Buoyancy, warmth, and
resistance are appealing attributes of this exercise
mode. Individuals who may not tolerate exercises
on land due to gravity may tolerate exercise in water,

Figure 10.7  A water chair (right side of photo, in pool) promotes inclusion and trunk stability for arm exercisers.
while injured athletes can make great gains by using
aquatic exercise. Aquatic exercise can aid recovery
from surgery, increase functional ability, and decrease
pain experienced during exercise (Levin, 1991). To
prevent injuries caused by poor flexibility, start the
participant slowly in chest- or neck-deep water,
controlling movements carefully and keeping them
underwater. The participant can move to progres-
sively shallower water as ROM increases. Moving to
shallower water provides more weight and gravity, to
continue improvement.
Specific conditions that inhibit ROM include
• abnormal stretch reflex in individuals with
cerebral palsy;
• contractures in individuals with muscular dystro-
phy, cerebral palsy, spinal cord injury, traumatic
brain injury, or stroke;
• surgery;
• scar tissue;
• heterotopic ossification (bone formation in soft
tissues around joints) in individuals with spina
bifida, polio, or multiple sclerosis;
• injury or joint capsule damage, or both, in indi-
viduals with sports injuries or arthritis; and
• unstable environment due to buoyancy.
When ROM is inhibited, swim stroke mechan-
ics will likely need altering to accommodate the
Aquatic Fitness and Rehabilitation 239
individual’s abilities. To improve ROM, encourage the
participant to stretch every joint twice a day almost
to the point of the discomfort threshold (not pain),
which is called overload. Explain that the participant
should never go beyond the initial sensation of dis-
comfort or bounce through a stretch, as injury will
occur. “To enhance flexibility, move joints through
their full ROM so muscles are stretched at least 10 per
cent over their resting length and held at the point of
tension (not pain) at least 20 to 30 seconds” (Burgess
& Davis, 1993, pp. 117-131).
A complex subject to broach is the issue of passive
ROM exercises. If a swimmer cannot move through
a normal ROM, does not have a physical therapist
or athletic trainer that works or consults with him,
and has no other exercise program beyond aquatics,
should you as the adapted aquatics or water exercise
specialist provide passive ROM? Where does passive
ROM end and tactile teaching begin? How does a
nontherapist provide the exercise needed while not
crossing over the professional boundary into clinical
service?
In the absence of specific participant requirements,
we recommend the following guidelines for passive
ROM exercises:
• Work in tandem for one session with a physi-
cal therapist or athletic trainer and learn the
specifics for helping the participant perform
flexibility activities.
240 Adapted Aquatics Programming
• Encourage the participant to initiate the move-
ment. To empower the individual in this capac-
ity, use gravity and keep the movements under-
water. If hip extension is the goal, for example,
have the participant lie in a supine position and
allow gravity to pull the leg down.
• Work in warm-water environments, as warm
water is important for flexibility, with 88 to
92 °F (31.1-33.3 °C) being the ideal water
temperature.
• Get medical clearance and have licensed thera-
pists or certified trainers provide, or outline for
you, ROM activities or specific movements
that you may safely facilitate when working
with individuals with the following conditions:
severe spasticity, joint contractures, osteoporo-
sis, heterotopic ossification, hypermobility, sub-
luxations, dislocations, tissue adhesions, joint
fusions, surgically implanted bars or pins, and
pain that has not been evaluated by a physician
(Lockette & Keyes, 1994).
• Be aware that wrist extension in people with
quadriplegia may be contraindicated due to
preserving tenodesis in the hand. Refer to
a physician or therapist before doing finger
extensions, as tenodesis helps with a somewhat
functional grip.
Enhancing Muscular Strength
and Endurance
Muscular strength refers to the external force that a spe-
cific muscle or muscle group can generate. Endurance
is the ability of a muscle group to execute repeated
contractions over a length of time sufficient to cause
muscular fatigue or to maintain a specific percentage
of the maximum voluntary contraction for a prolonged
time (ACSM, 2006, pp. 81, 83). Muscular strength and
endurance are essential components that individu-
als with disabilities need in order to perform ADLs,
including wheelchair propulsion on uneven surfaces,
walking with crutches or walkers, transferring, perform-
ing vocational skills, and using community facilities.
Strength and endurance are also important for proper
posture and for preventing injuries caused by muscle
weakness and skeletal instability.
Unfortunately, however, some individuals have
disabilities that affect muscle tissue directly or have
progressive disabilities that result in muscle atrophy
and strength loss. These individuals may not be able
to strength train the muscle groups. Strength training
at a low intensity is beneficial if the progression rate is
slow, if 70% of residual muscle mass is available, and
if the rate of intensity is monitored (Lockette & Keyes,
1994). Individuals requiring physician-approved
strength training include those with muscular dys-
trophy or other muscular degenerative disabilities,
multiple sclerosis, myasthenia gravis, or postpolio
syndrome. In these cases, strength training may be
contraindicated due to the risk of extreme fatigue or
the potential for actually causing permanent damage
to muscle fibers. These individuals (and all beginners)
may benefit most from muscular endurance training
at low intensities and low repetitions (Lockette &
Keyes, 1994).
Muscular strength and endurance training can
easily be modified in the pool. Resistance training
can be achieved with buoyant objects such as kick-
boards, pull buoys, floating barbells, noodles (see
figure 10.8), beach balls, and water wings for push-
ing down into the water with the hands and arms. In
addition, participants may wear hand paddles or fins,
or both, adding larger resistive surfaces for them to
move through the water, thereby improving strength
and endurance. Strap-on and handheld weights are
popular, but they should be used with caution by
people with joint problems or acute injuries. Have
these participants increase the speed of their move-
ments, which will increase the resistance underwater,
or increase water resistance by presenting a larger
surface area to the water (ARC, 2004a). For example,
a webbed glove (see figure 10.9) increases the surface
area of the hand without adding the risk of injury
that paddles may present. Elbow flexion (bicep curls)
performed underwater with an open hand rather than
a fist provides more resistance, making the move-
ment harder without requiring the use of resistive
equipment.
Typically, the muscles that participants need to
strengthen are those that are antagonistic to spastic
muscle groups, usually the extensor muscles of the
hip and wrist and the muscles on the front part of the
lower leg. Respiratory muscle strength and endur-
ance are important for people with asthma, spastic-
ity, scoliosis, and muscular dystrophy. You can help
participants develop respiratory muscle strength by
having them perform trunk exercises (e.g., sitting trunk
rotations and trunk flexion and extension), exhale
fully through rhythmic breathing, and blow bubbles
underwater.
Physical Conditions and Tips
for Aquatic Rehabilitation
Body alignment and position contribute significantly
to how a person feels. Maintaining proper body
alignment during exercise helps prevent injuries and
 Aquatic Fitness and Rehabilitation 241

Figure 10.8  Pushing down on a buoyant object is good for resistance training.

Photo courtesy of Sprint Aquatics

Figure 10.9  Webbed gloves generate more resistance and enhance muscular endurance.

contributes to an efficient exercise session. Body pos-
ture is defined as the position of the body in space,
while body alignment refers to the relative posi-
tions of the various body segments (Bishop, 2002).
Remember to emphasize good alignment during
exercise so that targeted muscle groups receive the
proper workout. Muscular strength imbalances can
also compromise posture. Therefore, it is especially
important to emphasize proper body alignment and
body position while exercising, as many adapted
aquatics participants have congenital or acquired
postural anomalies.
If you are an aquatics instructor and do not have
credentials in rehabilitation, you should never
administer active therapeutic intervention for indi-
viduals who have temporary disabilities or who are
recovering from recent surgery. If, however, you are
a therapist with no aquatic experience wishing to
use the water for rehabilitation, you should consult
an aquatics instructor for information about using
aquatics as an adjunct to rehabilitation. We wrote
this section of the chapter with the professional
therapist in mind. In it, we discuss the following
injuries and conditions: frailty, obesity, fibromyalgia,
242 Adapted Aquatics Programming
pregnancy, low-back pain, knee surgery, chon-
dromalacia, shin splints, plantar fasciitis, bursitis,
tendonitis, and stress fracture. Remember that when
you are working in aquatic rehabilitation with an
individual with a chronic or an acute injury, you
should first review the participant’s medical file to
learn about the side effects of medication that may
affect performance.
We have taken many of the following tips from
Norm and Hanson (1996), Prentice (2004), and Sova
(1992).
Frailty With Advanced Age
An elderly person is considered frail if he cannot
perform weight-bearing exercises, has some age-
related disabilities, or needs assistance to perform
activities of daily living and exercise. The aquatics
program should offer a physically and emotionally
safe environment, limit spinning and turning to mini-
mize the chance of dizziness, use slower movements,
and possibly use the gutter or chairs in the pool to
help with balance. Many elderly who are frail need
a longer, slower warm-up and need to work at their
own pace to feel comfortable. They may need to
have directions repeated due to poor hearing. Some
elderly may be incontinent and require tight-legged,
plastic panties. When developing a program for
elderly people who are frail, you must incorporate
all aspects of health-related physical fitness as well
as fine motor movement. Avoid having participants
grip equipment for prolonged times, as doing so
may aggravate joint problems such as arthritis. Aqua
mitts or webbed gloves can be helpful because they
increase resistance, thereby reducing the need to grip
resistance equipment tightly.
Obesity
Experts consider individuals who are 20% over
their recommended body weight to be obese (Wal-
lace, 2003). Workouts featuring low-impact, low-
intensity, and high-duration activity are best for this
group. If excess body weight has caused the partici-
pant to be clumsy, it may be appropriate to offer a
chair or bar for her to grasp. Excessive buoyancy
may make it difficult for an individual who is obese
to recover from both front and back horizontal posi-
tions. If necessary, teach the recovery to standing
using the side of the pool. This population is at a
high risk for developing heat-related illnesses due
to lack of proper heat dissipation; therefore, water
above 86 °F (30.0 °C) may be too hot for working
out (Sova, 1992).
Fibromyalgia
Water exercisers with fibromyalgia should strive to
increase exercise tolerance and endurance level
through flexibility and strengthening exercises. The
participant should emphasize slower progressions
rather than being too aggressive, exercising 2 to 3
times per week for 5 to 10 minutes and increasing by
2 to 3 minutes a week. Choose aerobic activities such
as walking and running in shallow or deep water.
Pregnancy
Aquatic workouts should maintain prepregnancy fit-
ness levels. Be sure, however, that the participant does
not become overheated and that her heart rate does
not exceed 140 beats per minute. Workouts should
be low impact, and 80 to 83 °F (26.7-28.3 °C) water
is ideal. Musculoskeletal injuries are common among
pregnant women due to a hormone released during
pregnancy that softens joint structures and increases
flexibility; therefore, tell the pregnant participant to
avoid overstretching. During standing exercises, the
swimmer should maintain a pelvic tilt (tighten but-
tocks and tilt pelvis toward head). Have her avoid
equipment that intensifies abdominal work, due to the
possible separation of abdominal muscles, and have
her stop if any pain or contractions occur. A pregnant
swimmer should reduce exercise intensity, frequency,
and duration as her body tells her to. Finally, never
contradict advice from the participant’s doctor, even
if it seems conservative.
Low-Back Pain
Twisting, jarring, and compressing the lower back
are the main contraindications for people with low-
back pain. Performing slow, controlled movements,
in addition to strengthening the abdominal muscles
and stretching the hip flexors, will help prevent or
heal low-back pain.
Knee Surgery
During swim strokes and exercise, a swimmer recov-
ering from knee surgery should limit knee flexion
to less than 75°, unless instructed otherwise by a
physician or therapist. The participant should avoid
bouncing and using weighted equipment, as well
as twisting with the feet planted on the bottom of
the pool. Moreover, breaststroke and elementary
backstroke kicks are usually contraindicated. During
all activities, the participant should keep his knees
directly above his feet, with the toes on each foot
always pointing in the same direction as the other

foot. Using a flotation device enhances exercising
in deep water, eliminating weight bearing while
encouraging increased ROM.
Chondromalacia
Water exercisers with chondromalacia should avoid
high-impact activity and excessive knee flexion and
extension. They should also avoid wearing weighted,
buoyant, or resistive equipment on their ankles and
doing the breaststroke, elementary backstroke, and
scissor kicks. Aqua shoes with an arch support help
during weight-bearing water exercise.
Shin Splints
Swimmers and water exercisers with shin splints
should ice their shins before and after exercise
and replace weight-bearing with non-weight-
bearing activities such as jogging in neck-deep water.
However, proceed with caution when using deep-
water jogging, as it may be contraindicated due to
increased plantar flexion and increased likelihood
of pain. During weight-bearing activities, encourage
participants to avoid jarring and stressfully landing on
the heel. Participants with shin splints can wear the
AquaRunners zero-impact footwear by Excel Sports
Science of Eugene, Oregon, during water exercise
to decrease the risk of impact-related injuries (see
appendix E). Although these shoes are made to add
resistance and buoyancy, participants can wear them
during exercise in shallow water as well.
Plantar Fasciitis
Water exercisers with plantar fasciitis should use aqua
shoes with an arch support during weight-bearing
exercises, avoid bouncing and jumping, and do as
much deep-water exercise as possible. Incorporate
stretching of the calf and Achilles tendon as much
as possible during the workout.
Bursitis
Swimmers and water exercisers with bursitis should
ice the affected area 20 minutes before and after
Aquatic Fitness and Rehabilitation 243
exercise and should avoid using weighted, buoyant,
or resistive equipment.
Tendonitis
Swimmers and water exercisers with tendonitis
should ice the affected area 20 minutes before and
after exercise, should strengthen the weak muscles,
and should stretch the opposing muscles of the
affected joint.
Stress Fracture
An aquatic exercise participant with a stress fracture
in a lower extremity should avoid weight bearing and
should perform deep-water exercise while wearing a
Wet Vest or an AquaJogger flotation belt.
Summary
Individuals with disabilities are often unsuccessful
exercising on land and are frequently viewed as
unhealthy by people without disabilities. However,
through water exercise, individuals with disabilities
can demonstrate more control over their lives and
contribute to their own health and wellness, thus
enhancing their quality of life. Despite physical and
psychological barriers that still remain in American
society, individuals with disabilities can develop and
maintain a level of physical fitness that can decrease
or prevent the risk of hypokinetic and other diseases.
Both aquatics instructors and therapists should help
individuals with disabilities set goals and objectives
and adapt equipment, environments, and skills to be
successful. Moreover, constant encouragement is a
valuable asset for helping individuals with disabilities
overcome the negative factors they must deal with.
Apply the health-related fitness concepts and
adaptations to aquatic fitness training for individuals
with disabilities to create programs that will meet
your participants’ fitness needs. Finally, refer to the
common conditions described in this chapter for
which experts recommend aquatic therapy, using the
tips to facilitate rehabilitation.
244 Adapted Aquatics Programming

Chapter 10
Review 1. Define health as the WHO advocates it.
2. Discuss the convergence of health and disability.
3. The measures of physical fitness that are used most frequently fall into
what two groups?
4. Define wellness as an approach to personal health.
5. In order for cardiorespiratory endurance to improve, what components
must be considered?
6. How do you calculate MHR?
7. Define the following terms: resting heart rate, maximum heart rate, heart
rate reserve, and target heart rate zone.
8. What formula would you use to calculate the THRZ for a participant who
uses her arms during swimming?
9. What are three alternative methods of monitoring exercise intensity?
10. Discuss programmatic concerns for providing aquatic rehabilitation pro-
grams.
11. Provide examples of how you can have participants use equipment to
enhance muscular strength and endurance training.
12. What are some ways in which you might modify water exercise routines
for individuals who cannot stand and perform the routines with the class?
 Part Iii

Program
Enhancement

245
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 11
Adapted Aquatics
Program Selection

T he Dickinson Family Counseling and Support Center has been receiving

requests from client families for access to an adapted aquatics swimming
program. The staff recreation coordinator has been assigned to locate or develop
an appropriate program. She realizes that several community-based organizations
have potential aquatics programs. However, she also knows that members of the
client families include individuals with diverse physical and cognitive disabilities.
Since the client families have limited resources, program accessibility and afford-
ability are important considerations. Her concern now is to select the best program
or programs that will meet the needs of the center’s clients.

247
248 Adapted Aquatics Programming

A dapted aquatics programs are increasingly more

available, accessible, and affordable, giving indi-
viduals with disabilities many options from which
information provide a foundation for tailoring aquatic
program decisions for individuals or groups.

to select a program that best meets their needs and

interests. Naturally, such diversity offers a range of
services and benefits, varying from meeting basic
therapeutic, fitness, or instruction needs to providing
enrichment activities through recreation, competition,
or sports. Moreover, programs are conducted in a
variety of settings and sponsored by many types of
organizations. This chapter provides an overview of
program features that you should know when starting,
selecting, or referring an individual to an adapted
aquatics program. Figure 11.1 summarizes various
considerations for program selection. Additionally,
this chapter identifies adaptations and enhancements
of established programs. Together, these sources of
Chapter Objectives
From this chapter, you will learn the
following:
* Participation in adapted aquatics
programs may occur in different envi-
ronments based on various selection
considerations.
* Differing program purposes and types of
participation provide additional selec-
tion considerations for adapted aquatics
programs.

Basic purposes Program environments

• Aquatics instruction • Community based
• Therapy • Residential
• Fitness and exercise • Hospital, therapeutic
• School

Adapted aquatics
program selection

Enrichment purposes Types of participation

• Recreation • Segregated or integrated
• Competition • Individualized or group
• Sports • Structured or unstructured
• Adventure

National sponsorship
• AAHPERD/AAPAR
• American Red Cross
• Jeff Ellis and Associates
• Special Olympics
• YMCA
• SwimAmerica

Figure 11.1  Considerations for selecting an adapted aquatics program.

E3344/Lepore/fig.11.1/278210/alw/r2

* Nationally sponsored aquatics programs
can provide guidance and resources
for developing adapted aquatics pro-
grams.
Program Environments
The mission of an organization often guides the deci-
sions that administrators and other staff members
make regarding program development and delivery.
The people in charge must determine which groups
the program will serve (children, adults, people with
certain disabilities, or people with other target char-
acteristics), what methods the instructors will use
(group, individual, segregated, or integrated), and
what specific content the curriculum will include
(social, water safety, therapeutic, or recreational).
Collectively, these decisions help a program establish
its unique approach within its setting. The sidebar
on this page lists criteria for matching an adapted
aquatics program to the specific needs and interests
of an individual with disabilities. Consider these cri-
teria when reviewing the differences among adapted
aquatics programs in the following sections.
Community-Based Programs
Organizations providing community-based delivery
of adapted aquatics services account for many of the
aquatics programs that are available to individuals
with disabilities. These organizations may be charac-
terized by their type of funding, governance, mem-
bership, and advocacy. They may vary with respect
Criteria for Selecting
an Adapted Aquatics
Program
❚ Purpose and goals of the program
❚ Program delivery models
❚ Target groups served
❚ Content of the program
❚ Qualifications and training of staff
❚ Type and amount of structure
❚ Services availability
❚ Accessibility to facility and program
Adapted Aquatics Program Selection 249
to private (not-for-profit) or public status, religious
affiliation, and level of volunteer involvement.
Private, not-for-profit organizations include
YMCAs, YWCAs, Boys and Girls Clubs, Jewish Com-
munity Centers, and Boy Scouts and Girl Scouts, all of
which serve the general public. Participants in these
programs are generally members who must pay dues
or other fees. These organizations may receive further
funding through grants, private contributions from
individuals, or funding agencies such as the United
Way. They may also allow nonmembers to take classes
or attend a particular program at the agency by paying
on a per-day or per-course basis.
The adapted aquatics programs provided through
these organizations serve many purposes. For
example, a Jewish Community Center might offer
an instructional program or open swim. A YMCA
might offer fitness, instructional, recreational, or
therapeutic programs. Moreover, individuals may
choose from segregated or inclusive programs, group
or individual instruction, and structured or unstruc-
tured sessions.
Public organizations—those organizations pri-
marily funded by federal, state, or municipal govern-
ment—providing adapted aquatics programs include
parks and recreation departments, schools, and other
publicly funded institutions. As with other not-for-
profit organizations, the programs conducted by
public agencies vary. Participation may be subsidized
or offered through membership or program fees. Com-
munity-based organizations or service groups might
sponsor programs using public facilities.
Community-based affiliates of disability-specific
organizations include the Spina Bifida Association,
NMSS, United Cerebral Palsy, and Special Olympics.
Some of these organizations provide primary service
to individuals with specific disabilities and their fami-
lies and friends and have private pool facilities that
they own and manage. Others secure pool time from
public and private facilities, such as high schools,
community centers, health clubs, and rehabilitation
facilities.
Some day or residential camps include adapted
aquatics as part of the curriculum. However, the
camp environment may affect participants with dis-
abilities in several ways. The duration of the program
is generally limited to the summer, and participants
may require time and energy to adjust to camp fac-
tors, including weather, other social and recreational
activities, daily routines, movement throughout the
camp, and camp regimens.
Adapted aquatics programs with a therapeutic
focus have increasingly turned to community-based
250 Adapted Aquatics Programming

resources. In these programs, allied health profes- Community-based settings may provide an
sionals, such as physical and occupational therapists, inclusive atmosphere and a convenient geographic
contract with the organization to use a community location, thereby ensuring program accessibility and
pool for individual or group therapy. Such a program encouraging participation in adapted aquatics pro-
may offer patients medically prescribed therapy as grams. Their appeal, however, may be influenced by
well as exercise, fitness, and swim instruction. Medi- such factors as the facility accessibility, the ease of
cal insurance usually covers part or all of the fees for transportation to the facility, the pool design and air
such services. temperature, the comprehensiveness of the programs,
and the quality of the instruction.

Community-Based Programs: Rocky Run YMCA

Rocky Run YMCA lives its philosophy of inclusion
and accommodating special needs through its
comprehensive program delivery, accessible
facilities, and targeted customer communica-
tions. The organization’s Special Needs Commit-
tee helps maintain the strategic focus. Program
brochures depict inclusive logos and encourage
individuals and their families to inform staff about
special needs so that the staff can implement
appropriate accommodations. Group and family
locker rooms and changing facilities are avail-
able. A Youth and Special Needs Wellness Center
provides a place for children aged 8 to 12 to par-
ticipate in a supervised program during specified
evening and weekend hours. Parent members
can also access Kid Zone Babysitting for 2 hours
a day. Membership is open to the community.
The Open Doors program, an income-based rate
scale, provides financial assistance to increase
Community-Based Program: Rocky Run YMCA, Media, PA.

affordability.
The Rocky Run aquatics facilities include a
typical six-lane pool, with the enhancement
of a walk-in ramp running half the pool length,
and a therapeutic pool that is accessible by lift
and has a water temperature maintained at 86
to 90 °F (30.0-32.2 °C). Progressive swimming,
recreational and lap swimming, scuba, aquatic
exercise, themed aquatic events, and competi-
tive swim clinics are available as inclusive pro-
grams for youth, adults, and families. Individuals
with additional special needs may participate
in adapted aquatics swimming, including
parent–child aquatics for school-aged youth
with special needs and adapted warm-water Rocky Run YMCA offers a community-based aquatics
exercise. The Rocky Run YMCA also sponsors program.
a Special Olympics program and collaborates
with community organizations serving special
populations to provide pool time and technical
programming resources.

Information provided by Rocky Run YMCA, 1299 West Baltimore Pike, Media, PA 19063, 610-627-9622, www.rockyrunymca.org.

Residential Programs
Although current trends in the United States encour-
age community-based, integrated living, some indi-
viduals with disabilities or their caregivers choose a
residential facility for care and educational, recre-
ational, and therapeutic opportunities. These facilities
may be public or private and may be for profit or not
for profit. They may offer nursing or medical care;
they may offer long-term or intermediate community
living arrangements (CLAs); or they may be residential
schools. Residential facilities may offer aquatics if
they have a pool or the ability to transport residents
to an aquatics facility.
Residents may vary in abilities, and their disabilities
may range from mild to profoundly involved. Indeed,
residential facilities use many criteria to establish who
they will serve, what programs they will provide,
and how they will provide programs and services.
A facility might provide services to individuals of a
certain age or might establish specific physical or
cognitive requirements. Staff members tend to follow
a transdisciplinary or cross-disciplinary approach.
They communicate with each other, pursue similar
objectives, and reinforce similar tasks, such as activi-
ties of daily living and functional skills.
Residency can facilitate the delivery of adapted
aquatics programs. Obviously, the program is more
readily accessible and accommodating, giving
residents more opportunities to participate in aquatic
activities. Since the residential facility is designed to
meet the needs of its residents, the aquatics facilities
are usually accommodating and accessible.
Staff members are better able to adjust the pool
conditions to meet the needs of the residents. How-
ever, staff members may confront several challenges
in a residential facility. They must maintain their
enthusiasm and commitment to the same residents,
day after day. They must deal with burdensome paper-
work for external organizations such as Medicare or
other funding or regulatory sources, which impose
regulations on and require documentation of the
amount and type of services offered the residents.
Staff members should strive to implement individual
goals and objectives that not only maintain function
but also develop new skills.
Hospital and Therapeutic
Programs
Treatment, care, and therapy are primary concerns
for individuals participating in aquatics programs
sponsored by hospitals and therapy facilities. Such
organizations may also provide supplemental pro-
grams that emphasize swim instruction, recreation,
Adapted Aquatics Program Selection 251
fitness, or competition, creating diversity in their
program offerings. An organization’s aquatics facilities
may range from a small therapy pool to a full-scale
swimming pool. Program staff may include PTs, OTs,
CTRSs, certified swimming instructors, aides, and
volunteers. If needed, such programs offer special
equipment to accommodate participant mobility
and therapy. Hospital and therapeutic programs may
have to deal with accrediting agencies and govern-
mental or private insurance carriers who may impose
regulations that affect program delivery. Moreover,
therapeutic pools often have different requirements
for lifeguarding, sanitation, and pool operation.
Aquatics programs conducted by rehabilitation
hospitals may combine aquatics instruction with
physical therapy. The programs may be augmented
with other recreational or fitness activities. Such pro-
grams may limit delivery to the times that the therapist
or instructor is available to work with patients one
on one. They are usually limited to inpatients or out-
patients of that hospital and are likely to be covered
by insurance submitted through the physical therapy
department. The pool is usually small, very warm
(88-90 °F, or 31.1-32.2 °C), and not conducive to lap
swimming or competition.
A hospital or therapy facility that has no pool may
choose to cosponsor an adapted aquatics program
with a community organization. Participants referred
by the hospital or affiliated doctors may pay reduced
program fees. In such an arrangement, the hospital
and community organization must determine how
to distinguish or share personnel, program expenses,
and program responsibilities. A benefit of this arrange-
ment is that individuals with disabilities gain more
exposure to and involvement with the community.
They can practice social and community living skills
with receptionists, volunteers, and other facility
members and meet other individuals, with or without
disabilities, in informal settings outside the hospital.
The community-based pool may also be better suited
to swimming instruction, recreational lap swimming,
or competition. The disadvantages of this arrangement
are that the program is still not fully integrated, the
pool temperature may be too low to be appropri-
ate for specific physical limitations, architectural
barriers may exist, and staff members or volunteers
may need training to assist with a particular special
population.
School Programs
Schools, from elementary schools to universities, may
conduct adapted aquatics programs for their students
during school hours and may sponsor programs for
the community throughout the week. As a part of the
 Residential Programs: Mary Campbell Center
The Mary Campbell Center (MCC) is a private facility that serves approximately 50 adults with severe
physical impairments. The MCC philosophy views individuals as residents and family members, not
as clients. Residents have access to a range of social, recreational, therapeutic, and daily care
services. The aquatics facility includes a 15- 3 32-foot (4.6- 3 9.8-meter) pool with a hydraulic floor,
an 8- 3 10-foot (2.4- 3 3.0-meter) spa with a hydraulic lift, fully accessible showers and locker rooms,
a laundry facility adjacent to the deck, and a fitness area with weights and aerobic exercise equip-
ment. Program personnel include five aquatics staff members with training in physical education,
recreation, and aquatics; volunteers; and ancillary PTs, OTs, and nurses.
The aquatics program provides each individual the support and skills necessary to achieve
maximum independence and freedom of movement. The program focuses on establishing a safe
environment for all participants; promoting independence, growth, and opportunities for new
experiences; providing structured exercise and carryover from physical and occupational therapy
regimens; and teaching swimming skills. All these endeavors increase participant self-esteem.
Staff members individualize all programs by focusing on specific instructional, recreational,
therapeutic, and social needs. They make comprehensive individual assessments, with input and
recommendations from professionals in physical therapy, occupational therapy, and physical
development. Staff members assess participants one on one to determine aquatic skill level and
then make recommendations at routine IAPP meetings.
To implement the aquatics program, staff members or volunteers work one on one with most
individuals and collect data from each session to provide feedback on participants’ progress. Each
session consists of a review of the skill and its components, practice, and application.
The following praise from three residents and one parent demonstrates how the pool program
has become an integral part of their lives: “The pool makes me feel better.” “I love to swim and then
go to the hot tub.” “My pool exercises make me stronger.” “My family and I watched my brother’s
face give way from slight trepidation to pure delight! The pool therapy opened up a whole new
world to him.”
Residential Program: The Mary Campbell Center, Wilmington, DE.

Mary Campbell Center offers a residential aquatics program.

Information provided by The Mary Campbell Center, 4641 Weldin Road, Wilmington, DE 19803, 302-762-6025, www.marycampbellcenter.org.

252
 Adapted Aquatics Program Selection 253

school curriculum, the adapted aquatics program is As an adjunct to the land-based physical education
generally conducted by a regular or adapted physical program, the primary purpose of these school-based
educator with aquatic expertise. The adapted aquat- programs is to provide swimming instruction. Partici-
ics instructor may support the regular instructor in an pants acquire aquatic skills that permit them to attain
aquatics class including an individual with a disability buoyancy, comfort, safety, fitness, and mobility in the
or may provide service in a supplemental or partially water. Participants may also enjoy recreational and
segregated program. The adapted aquatics program competitive swim activities.
may serve the students of that particular school or
may serve the whole district.

School-Based Programs: Osborn Aquatic Center

The Osborn Aquatic Center is an indoor community pool that the Corvallis School District uses to
provide adapted aquatics programs as part of its special education services. The program strives
to provide an environment in which individuals with physical or intellectual disabilities can partici-
pate regardless of their limitations. Staff members encourage an atmosphere of acceptance and
personal challenge, emphasizing activities that increase strength, endurance, and water skills.
Participants encourage and help one another through peer tutoring. The director of the adapted
aquatics program designs a specific program for each student, basing it on the participant’s physi-
cal abilities and limitations and taking into account input offered by the school district’s physical
therapist and by the participant’s classroom teachers and parents. Programs might include assisted
stretching, assisted walking, swimming with and without flotation devices, group activities, and free
time to explore and play.
Students are bused to the Osborn Aquatic Center throughout the day, 5 days a week. Their
disabilities include cerebral palsy, autism, mental retardation (currently referred to as intellectual
disability), Down syndrome, Prader-Willi syndrome, and developmental and emotional delays.
Photo courtesy of the Osborn Aquatic Center

Osborn Aquatic Center provides a school-based aquatics program.

Information provided by the Osborn Aquatic Center, 1940 NW Highland Drive, Corvallis, OR 97330, 503-757-5854.
254 Adapted Aquatics Programming
Program Purpose
A fundamental criterion for selecting an adapted
aquatics program is matching the purpose of the pro-
gram with the needs and interests of the individual.
Informal discussions, self-assessments, or formal
evaluations may determine which program best meets
the needs and interests of individuals with disabilities.
Basic aquatics programs might include instruction,
fitness, exercise, and therapy. Such programs and their
purposes are discussed in many places throughout
this book, especially in chapter 2, which examines
four models of service delivery. Aquatic enrichment
programs include recreation, sports, and competition.
See chapter 12 for more information about enrich-
ment programs.
Basic Needs and Interests
Programs
The ability to move safely and comfortably in the
water is achieved through programs whose basic pur-
pose is aquatics instruction. These programs include
safety and swimming skills. Competency with the
following skills may help ensure swimmer safety and
survival in the water:
• Submerging, breath holding, and breath con-
trol
• Water entry and exit
• Prone floating, back floating, and survival
floating
• Treading water
• Turning over and changing directions
• Elementary propulsive movements of arms and
legs
• Recovery from horizontal and vertical posi-
tions
Another purpose of aquatics instruction is to
develop good swimming strokes—strokes that
maximize efficiency and minimize effort. Individu-
als should acquire effective locomotion in the water
by improving head and body positions, arm and leg
propulsive movements, and rhythmic breathing and
coordination. The instructor’s role is to customize the
swimming stroke to best accommodate an individual’s
abilities.
Therapy is a basic purpose of adapted aquatics
programs in several environments. Many hospitals,
rehabilitation centers, and residential facilities pro-
vide aquatics programs to supplement, complement,
or replace land-based physical therapy. The aquatic
regimen may be prescribed to improve ROM, muscle
tone, balance, ambulation, and circulation. An
adapted aquatics instructor may be asked to provide
water activities that involve specific movements to
achieve desired results.
Individuals with disabilities may also seek adapted
aquatics programs to fulfill fitness and exercise
needs. Although these aquatic activities may result in
improvements similar to those provided by therapy
regimens, the activities are not necessarily moni-
tored or prescribed by medical professionals. Such
programs may supplement physical education or
the programs available through residential facilities.
Individuals may simply be interested in promoting
their personal wellness through the pursuit of lifetime
fitness activities.
Enrichment Programs
American society has progressed past the philosophy
that our duty is to simply meet the basic needs of
individuals with disabilities. Fortunately, the growing
cultural support for inclusion encourages opportuni-
ties for individuals with disabilities and empowers
these individuals to seek other opportunities that
will enrich their lives. Due to organizational efforts
to maintain customer satisfaction, the development
of expanded programs and facilities that meet the
desires, not just the needs, of individuals with disabili-
ties has been pursued. The field of aquatics has been
affected by these developments and has responded
with challenging and fulfilling opportunities in sports,
competition, and recreation. Swimming may be
used as a focus on a sport interest or combined with
other aquatic skill pursuits. Inner-tube water polo or
water basketball provides opportunities for sports
and recreation and for general fitness. Recreational
swimming, pool volleyball, and lap swimming also
revolve around aquatics as an enriching activity.
Competitive swimming is another obvious exam-
ple of an enriching aquatic activity. Disability sport
groups provide competitive swimming outlets to all
populations of swimmers with disabilities. These
groups may provide local, regional, and national
meets but have very few full-time training programs.
An individual with a disability who wants to swim
competitively usually self-trains, finds an interested
coach to help, goes to a community-based orga-
nization or rehabilitation hospital that sponsors a
particular disability group swim team, or participates
in a community-based, nonsegregated competitive
swim program.

A Competitive Focus
The Virginia Wadsworth Wirtz Sports Program
is conducted by the Rehabilitation Institute of
Chicago (RIC). The swim program of the RIC
Wirtz Sports Program is organized as a recre-
ational and competitive program and is not
meant to be a therapeutic aquatics program.
A basic mission of the program is to include
individuals with any physical disability in a
competitive swimming and training program.
Participants are encouraged to strive to com-
pete. One participant stated, “Swimming has
improved my ability to perform ADL (activities
of daily living) activities. It has increased my fit-
ness level and enabled me to compete again
when I thought I never would be able to.”
During the required initial pool evalua-
tion, new participants must demonstrate
the potential to achieve independence
with recreational or competitive swimming,
including recovery skills from each stroke
position and the ability to negotiate the pool
environment (locker rooms, pool deck, and
pool access points). Training during the swim
season includes drills, dry-land training, and
cardiovascular fitness. Swimmers and coaches
develop training goals together. Swimmers
are evaluated each meet to monitor their
progress from the previous year. Individuals
are provided opportunities to achieve goals
at various competitive levels.
The Virginia Wadsworth Wirtz Sports Program, Rehabilitation Institute of Chi-
cago, 345 East Superior, Chicago, IL 60611, 312-238-5001, www.richealthfit.org.
Types of Participation
Another feature to consider when selecting an
adapted aquatics program is the type of participa-
tion provided by the program. Programs may be
segregated (focusing on individuals with specific
disabilities) or inclusive (serving both individuals
with and without disabilities). A community facil-
ity may provide programs for the general public in
which individuals with disabilities are integrated with
regularly scheduled programs. The same facility may
opt to conduct a program just for individuals with
physical disabilities who have limited ambulation
or target a program just to individuals with intellec-
tual disabilities. The organization may serve only a
segregated population, such as a school for students
who are blind.
Adapted Aquatics Program Selection 255
The type of program may dictate the ratio of
instructors and aides to participants. A residential
facility with individuals who have profound disabili-
ties may provide one-on-one instruction and atten-
tion. Even if the individuals are brought together for a
group activity, the program maintains individualized
assistance. Other programs may routinely instruct
groups of 5 to 10 participants. The individual’s abili-
ties, instructional needs, and personal desires should
determine which setting is most beneficial.
The amount of structure provided during an aquat-
ics program pertains to the needs and desires of the
participants. Highly structured instructional classes
or fitness activities may produce the best results for
some people. This environment permits achievement
through logical learning progressions, corrective
and positive feedback, and sufficient practice. Other
people may prefer an unstructured environment that
allows them to progress at their own rates, to self-
direct, to explore their aquatic abilities at will, and
to select desired aquatic activities. Perhaps more
common and helpful, however, are those programs
that balance both approaches.
Nationally Sponsored
Adapted Aquatics Programs
Many adapted aquatics programs are built on a foun-
dation of established, progressive swimming programs
for diverse populations. The established progressive
programs present skills in developmentally appro-
priate sequences to promote success. Subsequently,
adapted aquatics programs customize supplemental
methods, skills, and knowledge to meet the needs of
specific populations. These programs may focus on
swimming skills or meet other needs such as fitness
and rehabilitation. Instructors benefit from training
in established progressive swimming programs and
adapted programs.
Several organizations have well-recognized and
nationally developed, sponsored, and supported
aquatics programs (see chapter 1 for the histories of
several organizations). They either provide or support
programs in adapted aquatics. This chapter highlights
organizations that offer programs meeting a variety
of purposes for delivering adapted aquatics. The
selection of organizations represents comprehensive
program development and delivery. See chapter 12 for
organizations that support adapted aquatics enrich-
ment activities other than swimming.
256 Adapted Aquatics Programming
American Alliance for Health,
Physical Education, Recreation
and Dance
The American Alliance for Health, Physical Education,
Recreation and Dance (AAHPERD) has filled a critical
gap in the delivery of adapted aquatics programs by
providing national training and credentialing pro-
grams for individuals who want to develop and con-
duct adapted aquatics programs. The Adapted Aquatic
Specialty Committee of the American Association for
Physical Activity and Recreation (AAPAR) Council
for Aquatic Professionals sponsors several levels of
adapted aquatics professional development.
• The Adapted Aquatics Assistant (AAA) course
trains individuals to work under the supervision
of an Adapted Aquatics Instructor.
• The Adapted Aquatics Adjunct (AAAdj) course
prepares professionals to conduct adapted
aquatics programs, also under the supervision
of an Adapted Aquatics Instructor.
• The Adapted Aquatics Instructor (AAI) course
trains currently certified aquatics instructors
with specialty skills, knowledge, and attitudes
for implementing adapted aquatics programs in
a variety of settings.
• The Master Teacher of Adapted Aquatics
(MTAA) course prepares AAIs to conduct the
AAI course (www.aahperd.org/aapar/template.
cfm?template=aa_overview.html).
Each of these levels has associated age, knowledge,
and skill prerequisites and course and credentialing
requirements (see appendix F for more comprehen-
sive descriptions). Training workshops are offered
through host sites located throughout the United
States and at AAHPERD conventions. Information on
training, registration, and hosting can be found on the
AAHPERD Web site (www.aahperd.org/aapar).
American Red Cross
Since the 1940s, the American Red Cross (ARC) has
provided various types of adapted aquatics programs
and special training for instructors who wish to
conduct such programs. The primary focus of these
programs has been to provide instruction in aquatic
and safety skills.
Since 1992, the ARC has embraced the phi-
losophy of including individuals with disabilities in
regular programs, integrating related professional
development materials with the regular Water Safety
Instructor (WSI) program. This redesign eliminated
a segregated ARC adapted aquatics program and
instructor training.
The revised 2004 ARC Learn-to-Swim program
includes six levels of aquatic and safety skill achieve-
ment presented in a logical learning progression.
Levels 1 though 5 aim to improve basic swimming
skills, develop and refine swimming strokes, reinforce
general and personal water safety skills, and intro-
duce skills for helping others (ARC, 2004b). Level 6
permits a swimmer to refine strokes and turns, build
endurance, and participate in activities specific to
one of the following areas of interest: personal water
safety, fundamentals of diving, fitness swimmer, and
lifeguard readiness. Program participants learn to
adapt a swimming stroke to their individual abilities
and body characteristics, despite limitations.
The Water Safety Instructor’s Manual (ARC,
2004b) provides technical guidance and resources
for implementing learn-to-swim programs. It also
includes course outlines for parent-and-child aquat-
ics programs, which target children aged 6 months
through 5 years. A practical enhancement of this
manual is the section Customizing the Program, which
discusses customizing for disabilities, customizing for
adults, customizing by integrating fitness components,
and customizing with games and water activities.
The instructor training program, a 30-hour curricu-
lum, includes practice teaching and role-playing to
reinforce effective practices for delivering structured
aquatics programs to diverse populations.
Jeff Ellis and Associates Inc.
Since the 1980s, Jeff Ellis and Associates Inc. (E&A)
has offered a variety of lifeguarding, water safety, and
aquatics risk management courses to water parks and
other aquatics facilities throughout the United States.
In the 1990s, E&A collaborated with the National
Safety Council and the National Recreation and
Park Association to develop a learn-to-swim program
(www.jellis.com). Jeff Ellis Swimming encourages
rapid success with a positive and fun approach,
promotes lifelong aquatic enjoyment, and reduces
drowning risk.
Three different program components are avail-
able, depending on the swimmer’s age. The Water
Exploration Series is designed for adults and their
children aged 6 months through 3 years. It introduces
children and their caregivers to developmentally
appropriate water activities that permit a safe and
shared experience. Children aged 3 through 6 years
can participate in the Preschool Series. This series
emphasizes themed learning through seven adven-
tures, integrating the parent with the child’s learning
process. Each level has its own story and skill sheet

that breaks down skills into a simple format. The
Challenge Series is a performance-based swimming
program designed for all ages through adult. Struc-
tured in a flexible lesson format for novice, advanced,
and expert levels, this series presents challenges for
improving stroke, safety, and fitness. Refer to www.
jellis.com for contact information.
Although the E&A program is not specifically
designed as an adapted aquatics program, it features
developmentally appropriate, progressive skills that
facilitate the inclusion of children and adults with
disabilities in a standard aquatics program. Instruc-
tors decide what, when, and how to teach, making
it possible for them to meet the needs of individuals
with disabilities. Supplemental materials include an
adapted aquatics segment. The program is adminis-
tered by licensed coordinators who must meet train-
ing and auditing criteria to retain their licenses.
Special Olympics
As described in chapter 1, Special Olympics has a
history of being a leader in developing programs for
individuals with intellectual disabilities. It promotes
itself as having the world’s largest program of sport
training and athletic competition for children and
adults with intellectual disabilities, offering more
than 200 programs in 150 countries (www.special
olympics.org/special+olympics+public+website/
english/compete/default.htm). The aquatics programs
provide opportunities for participation in instruction,
fitness, and recreation activities; competition and
sports; and psychological and social development
activities.
Special Olympics is sustained through volunteer
resources. Individuals volunteer their time to manage,
coordinate, and conduct all parts of the program.
Organizations voluntarily give pool time and space
for aquatic activities. The programs are often con-
ducted in schools, community-based centers, and
residential facilities. Participation in Special Olympics
aquatics programs has traditionally been segregated,
with both individual and group instruction. Coaches
structure activities, identifying goals and objectives
for each participant.
Aquatics is one of 30 Special Olympics sports
for individuals 6 years and older, and competition
opportunities for individuals 8 years and older exist
at international, national, and local levels. The vari-
ous swimming events make aquatics appropriate for
a range of ages and ability levels. Although competi-
tion events include a variety of traditional swimming
strokes, other events exist so that athletes with lower
levels of ability may train and compete in basic
aquatic skills. Special Olympics provides detailed
Adapted Aquatics Program Selection 257
coaching guides for developing training and com-
petition programs. These guides can be downloaded
from the Special Olympics Web site (www.special
olympics.org/special+olympics+public+website/
english/coach/coaching_guides/default.htm).
The downloadable Aquatics Coaching Guide is a
practical, organized, all-inclusive tool for coaches
and other individuals with broad responsibilities for
developing a Special Olympics aquatics program. It
includes information and resources to accomplish
the following program components:
• Setting and assessing individual goals
• Planning a competition season
• Planning and conducting aquatics training
sessions
• Teaching aquatic skills
• Understanding sport rules, protocol, and eti-
quette
• Selecting and managing a team
• Preparing for and participating in competition
• Coaching practices and principles
• Using aquatics attire and equipment
• Managing safety and risk
Information and tools specific to the training
responsibilities of coaches are detailed in a second
Special Olympics guide, the Aquatics Coaching Quick
Start Guide. It includes checklists, diagrams, tables,
charts, and sample plans to help a coach conduct
training sessions. Progressions for swimming strokes
and other competitive skills are clearly described,
along with corresponding “faults and fixes” sugges-
tions and guidelines for assessing swim strokes.
Special Olympics also promotes other initiatives to
enhance the experiences of its athletes. An inclusion
program, Unified Sports, combines Special Olympics
athletes and athletes without intellectual disabilities
(as partners) on sports teams for training and competi-
tion. In Unified Sports aquatics, a relay team consists
of two Special Olympics athletes and two partners.
(www.specialolympics.org/special+olympics+public
+website/english/compete/sports_offered/aquatics.
htm). Coaches who need a resource for starting and
maintaining such a program can download a Unified
Sports handbook from the Special Olympics Web site
(www.specialolympics.org/special+olympics+public
+website/english/compete/unified_sports/default.
htm). This initiative provides athletes with the oppor-
tunity to learn new sports, develop higher level skills,
gain new competition experiences, experience inclu-
sion, socialize, and participate in activities outside
Special Olympics.
258 Adapted Aquatics Programming
The Athletic Leadership Programs (ALPs) initia-
tive (www.specialolympics.org/special+olympics
+public+website/english/initiatives/athlete_leader
ship/default.htm) encourages athletes to participate
in nontraditional roles, such as members of boards
of directors or local organizing committees, team
captains, coaches, and officials. The program mimics
the principles of Special Olympics to promote dignity
and empowerment.
The Special Olympics Healthy Athletes (www.spe
cialolympics.org/special+olympics+public+website/
english/initiatives/healthy_athletes/default.htm) initia-
tive aims to improve athletes’ abilities to train and
compete by improving health and fitness, resulting
in an enhanced sport experience and improved well-
being. Strategies and activities include improving
access and health care at health screenings, making
referrals to health practitioners, training health care
professionals about the needs and care of people
with intellectual disabilities, managing information
on the health status of individuals with intellectual
disabilities, and advocating for improved health poli-
cies and programs.
Young Men’s Christian Association
Unlike the ARC and AAHPERD, the Young Men’s
Christian Association (YMCA) does not need to
depend on other organizations to sponsor its adapted
aquatics programs. It has community-based branches
and camps for providing aquatics programs. YMCA
branches may offer segregated or inclusive programs,
or both, for individuals with disabilities. The national
YMCA has developed comprehensive aquatics pro-
grams for progressive swimming, aquatic fitness and
exercise, competitive swimming, aquatics for special
populations, and activities including scuba, water
polo, and synchronized swimming. It also provides
programs to train leaders, instructors, and trainers spe-
cific to each of the aquatics programs. Basic aquatics
programs and leadership training are offered through
local branches.
Like the ARC, the YMCA’s basis for aquatics is its
progressive swimming program. The youth and adult
aquatics program is divided into seven successive
levels, including polliwog, guppy, minnow, fish,
flying fish, shark, and porpoise. Each level focuses
on personal safety, personal growth, stroke develop-
ment, water games and sports, and rescue. In addi-
tion, the YMCA also provides a parent-and-child and
a preschool aquatics program. Various instructor and
trainer certifications are available for each of these
programs. Several support manuals, including The
Youth and Adult Aquatics Program Manual (YMCA,
1999a), Teaching Swimming Fundamentals (YMCA,
1999b), and The Parent/Child and Preschool Aquatic
Program Manual (YMCA, 1999c), provide guidance,
essential information, program objectives and out-
lines, and basic skill analyses for conducting the
YMCA aquatics programs. A general philosophy of
inclusion exists throughout the materials.
The YMCA provides supplemental guidance for
adapted aquatics programs in its Aquatics for Special
Populations program. The instructor course trains
instructors to teach swimming and water safety skills
and knowledge to individuals with disabilities.
The YMCA also collaborates with the Arthritis
Foundation to provide a nationwide Arthritis Founda-
tion Aquatic Program (AFAP). When offered at YMCA
branches, it is designated as AFYAP. This nonclinical
program leads individuals with arthritis through a
regimen of exercises that improve flexibility, decrease
pain, lessen join stiffness, and increase stamina
without putting excess strain on joints and muscles
(www.arthritis.org/events/getinvolved/Programs
Services/aquaticprogram.asp). An advanced level
(AFAP Plus or AFYAP Plus) is available at some
facilities for people desiring a more rigorous program.
Aquatics staff members who want to provide this pro-
gram must successfully complete an AFYAP Instructor
or AFAP Leader/Instructor training program.
SwimAmerica
Relatively new among nationally sponsored learn-
to-swim programs is the American Swimming
Coaches Association’s (ASCA) program, SwimAm-
erica. Designed by professional swim coaches, this
program emphasizes the station method to teach
infants through adults to swim. The program identifies
general goals and corresponding levels of advance-
ment, including the following 10 stations, or levels
(SwimAmerica, n.d.):
1. Bubbles
2. Floats and glides
3. Kicking
4. Crawl stroke
5. Freestyle
6. Backstroke
7. Breaststroke
8. Turns
9. Lifetime strokes
10. Individual medley

Swimmers must meet a total of 25 objectives to
advance through the 10 stations. Each objective
includes specific skills and criteria for advancing to
the next station. Thus, through the station method,
instructors use logical teaching progressions to intro-
duce and build new skills, while constantly reviewing
previous skills.
Although SwimAmerica does not specifically pro-
vide guidelines for including children and adults with
disabilities in its programs, with the proper training
and licensing, you could use it as an alternative or
supplemental program for teaching adapted aquatics
(see chapter 1).
Coaches are eligible to operate SwimAmerica
programs after appropriate training and licensure as
a program director. Program directors may train their
own staff. Licenses never expire and continuing edu-
cation is provided in monthly newsletters. Individuals
who operate SwimAmerica programs must adhere to
the following requirements (SwimAmerica, n.d.):
• Be a Certified Coach Member of ASCA
• Train coaching staff with materials and methods
described in the operations manual
• Use the SwimAmerica awards system
• Have the program director (or site supervisor)
on deck, actively directing each lesson
• Submit appropriate records to SwimAmerica
on schedule
Professional Development
Sponsorships
As the field of adapted aquatics developed, many
organizations realized the value of providing related
training for its professionals or members. Several
organizations have offered supplemental training
or professional development to prepare individuals
who are working with target populations. A primary
focus of such training is to adapt the sponsoring
organization’s established program to the aquatic
environment in a way that better serves individuals
with specific disabilities.
• The National Multiple Sclerosis Society (NMSS)
endorses aquatic activity regimens for individuals
with multiple sclerosis. Accordingly, many of its chap-
Adapted Aquatics Program Selection 259
ters throughout the United States sponsor aquatics
programs (www.nationalmssociety.org). Professionals
working with individuals with multiple sclerosis can
contact NMSS or local chapters for training oppor-
tunities and resources.
• The Aquatic Therapy and Rehabilitation Insti-
tute (ATRI) is a nonprofit education organization
providing professional development for health care
professionals involved with aquatic therapy (www.
atri.org). It offers continuing education courses for
aquatic therapists. ATRI provides public information
about aquatic therapy and serves as a resource to
organizations with health care professionals. It also
offers education and training to achieve International
Council for Aquatic Therapy and Rehabilitation Indus-
try Certification (ICATRIC).
• The Aquatic Exercise Association (AEA), a
nonprofit organization, focuses on the growth and
development of the aquatic fitness industry (www.
aeawave.com). AEA certification requires success-
ful completion of the Aquatic Fitness Instructor or
Aquatic Fitness Professional certification exam and
additional CPR certification and continuing educa-
tion credits.
Summary
Many adapted aquatics programs are currently avail-
able. Make it your aim to meet the developmental
needs and interests of each individual seeking a pro-
gram. To this end, use the various program features
discussed in this chapter when selecting an adapted
aquatics program. Consider the basic purposes of each
program, including instruction, therapy, fitness, and
enrichment (see also chapter 10). Choosing the most
suitable environment—whether a community-based
facility, residential facility, hospital, rehabilitation
center, or school—is also basic to meeting individual
needs and interests. Selecting the type of participa-
tion, from segregated to integrated, individualized
to group, and structured to unstructured, is another
important issue. Finally, examining the structures and
standards practiced by nationally sponsored programs
will help you compare programs as you strive to select
the best option for each individual and to pursue
additional professional development.
260 Adapted Aquatics Programming

Chapter 11
Review 1. Describe four settings in which an adapted aquatics program might be
provided and how program goals might vary among these settings.
2. List several types of community-based organizations that could sponsor or
implement adapted aquatics programs.
3. Identify two purposes for providing adapted aquatics programs and the
types of programs that represent such purposes.
4. Describe how adapted aquatics programs might vary among organiza-
tions with respect to types of participation.
5. Identify five national organizations that provide swimming programs that
can support the implementation of an adapted aquatics program.
 12
Competitive and
Recreational
Activities

J   ohn’s story is one of being in the wrong place at the wrong time. He was a
successful and popular high school athlete. The irony is that it was his warm
personality that positioned him for a lifelong change. When his friends beckoned
him while he was cruising past a local hangout, he parked his car and waited at
the side of the road for the traffic to pass. A drunk driver crested the rise in the
road, lost control of his car, and struck John, resulting in T10 paraplegia. After his
rehabilitation, John was looking for a way to participate in sport, and when he was
passing a triathlon event one day, he saw a participant cranking a handcycle.
The rest of John’s story is history, and today he trains hard to be the best triathlete
possible. When asked which triathlon event is his favorite and why, he responded,
“Swimming, because there are more girls at the beach!”

261
262 Adapted Aquatics Programming
P articipation in aquatic activities by individuals
with disabilities continues to increase, permeat-
ing all levels from infant swim programs to high-risk
recreational activities. Driving forces behind the
growing participation include federal and state leg-
islation, parental involvement, enhanced facility and
program accessibility, and societal acceptance of an
increasingly diverse population. However, the most
dynamic and important contribution has been the
desire of individuals with disabilities to take control
of the decision-making process in their lives. This
enduring change in attitude toward more indepen-
dence has resulted in a shift from accepting the role
of passive participant to demanding inclusion as an
active participant. The world of competitive swim-
ming, recreational swimming, and water adventure
activities, including scuba diving, boating, open-
water swimming, and waterskiing, is now open to
people with disabilities, and the opportunities are
continually expanding. In this chapter, we focus on
competitive swimming for individuals with disabilities
(see figure 12.1), equitable competition and classifica-
tion, coaching swimmers, and recreational aquatic
activities for individuals with disabilities. Make it your
goal to provide these opportunities, when appropri-
ate, or to serve as a well-informed liaison between
your participants and the appropriate enrichment
programs, thus facilitating a smoother transition from
basic to enrichment activities.
Photo courtesy of Dr. Gail Dummer
Figure 12.1  True competition recognizes ability.
Chapter Objectives
From this chapter, you will learn the
following:
* Federal legislation has positively influ-
enced sport participation by people
with disabilities.
* There are integrated and segregated
competitive swimming opportunities for
people with disabilities.
* Classifications for competition can be
made equitable for athletes with disabili-
ties.
* Coaches have a responsibility to all their
athletes for providing a socially safe
environment and professional coaching
techniques.
* Numerous water activities and various
modified equipment are available for
individuals with disabilities.
Effect of Legislation on
Aquatics Participation
Numerous public and professional organizations have
declared publicly that aquatics programs should be
given priority in educational, recreational, and com-
petitive venues. In a position paper on high school
aquatics, the Council for Aquatic Professionals within
AAHPERD states that
aquatics should be an important part of each high
school student’s physical education program. Applica-
tion of aquatic knowledge and skills not only improves
an individual’s physical fitness but also establishes
framework for an active leisure pursuit appropriate
throughout the life span. (AAHPERD, n.d.)
Federal legislation has also contributed signifi-
cantly to the provision and accessibility of competi-
tive and noncompetitive aquatic activities for indi-
viduals with disabilities in school, university, and
community environments. The following sections
identify legislation that addresses aquatics in physical
education and participation in interscholastic athlet-
ics, reflecting society’s desire to provide inclusive,
accessible aquatics for everyone. Follow the intent
of each federal law and determine when aquatics
participation can be requested according to that
statute. For a more comprehensive discussion of such
legislation, see chapter 1.

Rehabilitation Act of 1973
The Rehabilitation Act of 1973 (PL 93-112) stands as
the first major federal law protecting the civil rights
of and preventing discrimination against people with
disabilities. This major civil rights act mandates acces-
sibility to sport programs conducted by agencies that
receive federal financial assistance (i.e., public schools
and universities). However, the implementation of this
act did not occur until the publication of section 504
and the Rules and Regulations in 1977, which states
in the Federal Register (1977b) that
no otherwise qualified handicapped individual in the
United States shall, solely by reason of his handicap,
be excluded from the participation in, be denied the
benefits of, or be subjected to discrimination under
any program or activity receiving federal financial
assistance.
This statement means that schools conducting
interscholastic athletics (i.e., aquatics) and other
school activities must provide individuals with
disabilities who are otherwise qualified an equal
opportunity to participate, alongside students without
disabilities, in the activity.
Individuals With Disabilities
Education Act
As defined in the Individuals with Disabilities Edu-
cation Act (IDEA) (PL 101-476), special education is
instruction that is specially designed, at no cost to
the parent, to meet the unique needs of a child with
disability, including classroom instruction, instruc-
tion in physical education, home instruction, and
instruction in hospitals. Physical education is defined
as the development of physical and motor fitness,
fundamental motor skills and patterns, and skills in
aquatics. Therefore, it seems that aquatics program-
ming should be a priority in formal education and
thus in special education. IDEA mandates, as part of
the IEP, a statement be provided regarding transition
services and interagency responsibility no later than
16 years of age. Aquatics serves as an excellent tran-
sitional activity to community recreation participation
after graduation from high school. (See chapter 1 for
more details.)
Olympic and Amateur Sports Act
In 1975, President Gerald Ford formed the President’s
Commission on Olympic Sports. In 1977, the Final
Report of President’s Commission on Olympic Sports
was published, which formed the basis for the sign-
ing of PL 95-606, or the Amateur Sports Act (ASA),
Competitive and Recreational Activities 263
into law on November 8, 1978. The purpose of the
ASA was to
promote and coordinate amateur athletic activity
in the United States, to recognize certain rights for
U.S. amateur athletes, to provide for the resolution
of disputes involving national governing bodies
(NGBs), and for other purposes. (Amateur Sports
Act, 1978, p. 371)
In 1998, the Olympic and Amateur Sports Act
(OASA) (PL 105-77) replaced the ASA. The OASA
directed the United States Olympic Committee
(USOC) to absorb the various sport organizations for
people with disabilities and to recognize any sport
that is included on the program of the Paralympic
amateur sport organizations as NGBs. The USOC
was directed to recognize only one NGB for each
sport and to represent the United States as its national
Olympic committee in the country’s relations with
the national Paralympic Committee and the Interna-
tional Paralympic Committee. However, this move
diminished the role of disability sport organizations
(DSOs) in developing the elite athlete and on the
international scene, while increasing the role of the
U.S. Paralympics and the NGBs.
Competitive Swimming for
Individuals With Disabilities
Competitive opportunities exist in a variety of settings,
including short- and long-course swimming, where
events are conducted in typical Olympic style. USA
Triathlon and the International Triathlon Union (ITU)
have divisions for athletes with disabilities including
physical disabilities and vision loss. Other activities
include diving, provided by the Special Olympics,
and competitive water polo, provided by the Ameri-
can Athletic Association of the Deaf (AAAD).
USA Swimming is the NGB for competitive swim-
ming in the United States, including competitive
swimming for people with disabilities, and competi-
tion is conducted according to USA Swimming rules
and regulations. These rules and regulations also
provide guidelines for officiating swimmers with dis-
abilities, such as permissible alternative starting posi-
tions, turns, and finishes and reassignment of lanes.
Article 105 states, “The USA-S Rules and Regulations
grant the Referee the authority to modify the rules for
the swimmer with a disability. Disability is defined
as a physical or mental impairment that substantially
limits one or more major life activities” (USA Swim-
ming, 2005, p. 53).
264 Adapted Aquatics Programming
Philosophy of Competitive
Swimming
Since World War II, and particularly in the last 25
years, more and more sporting associations have
provided competitive opportunities in aquatics for
individuals with disabilities. Although water is a great
equalizer, swimming ranks only third as the sport with
the greatest number of competitors with disabilities
(Paciorek & Jones, 2001).
As with other sports, integration of athletes with
disabilities into general competition has been a goal
of disability sport advocates for over a decade. In the
United States, USA Swimming has done an exemplary
job of advocating for vertical integration, or the inclu-
sion of people with disabilities into general aquatic
meets and teams. USA Swimming is the NGB for all
U.S. swimming competition and has a national Dis-
ability Swimming Committee. This committee acts as
consultant to the USA Swimming Disability Cham-
pionships and as advocate for swimmers with dis-
abilities; the committee has written several resources
for coaches, local swim committees, officials, meet
directors, parents, and swimmers with disabilities
(USA Swimming, 2001). The USA Swimming (2005)
Rules and Regulations has guidelines for officiating
swimmers with a disability.
The goal of USA Swimming is for swimmers with
disabilities to train with their local swim clubs and
participate in swim meets combining swimmers with
and without disabilities during events. In addition to
integrated swim meets, the USA Swimming Disability
Championships are held once a year in the spring.
This swim championship is conducted for elite swim-
mers who have met qualifying times for their events.
USA Swimming rules and regulations apply during
these meets; however, disability sport classifications
are used so that swimmers can compete against others
with a similar level of functioning. Swimmers with
disabilities often have atypical stroke mechanics and
power because of missing limbs, neurological disor-
ders, cognitive delays, paralysis, or vision and hearing
loss that do not afford them the ability to compete
equally with one another—or even with swimmers
who have the same disability. Thus, swimmers are
classified into categories according to their functional
ability rather than simply separated by gender and
swim stroke.
USA Swimming encourages the integration of
swimmers with disabilities into meets people with-
out disabilities compete in by providing reasonable
accommodations to barriers that might otherwise
preclude them. According to USA Swimming, local
swim committees are encouraged to develop special
administrative procedures and circumstances that
encourage swimmers with disabilities to participate,
such as the following:
• Including a statement welcoming swimmers
with disabilities and providing notice of needed
accommodations
• Developing standards for seeding a swimmer
that do not interfere with the timetable and flow
of the meet but also do not place the spotlight
on the athlete with a disability (for example,
placing swimmers who have cerebral palsy in
a 100-meter event but having them swim 50
meters if their 50-meter time is similar to the
100-meter times of peers without disabilities)
• Waiving standards for qualifying times
Additional guidelines for officiating meets with
swimmers with disabilities include the following
accommodations from the 2005 USA Swimming
Rules and Regulations:
• Allowing the swimmer to start in the water
• Allowing the swimmer’s assistant on the deck
or in the water to assist the start
• Using a visual starting system (e.g., a strobe
light or hand signal) for deaf and hard-of-hear-
ing participants
• Allowing leniency in the time it takes to get into
the starting position
• Allowing modified starting positions on the
blocks, deck, or gutter
• Allowing tappers, or assistants who hold a pole
with a soft tip to tap the swimmer at turns and
finishes, for swimmers with vision impairment
(however, it is the swimmer’s responsibility to
provide the tappers)
• Using physical touch to signal a relay swimmer
when their teammate has touched the wall
• Not judging a part of the body that is absent
or not used as part of a legal–illegal stroke
technique
In the United States, most competitive training
takes place within USA Swimming clubs; the YMCA
and other organizations conduct integrated club
teams as well. For people who prefer training only
with swimmers who have disabilities, segregated dis-
ability sport organizations such as Special Olympics
(for athletes with intellectual disabilities) and USA
Deaf Sports Federation (USADSF) (whose members
participate in the Deaflympics) provide segregated
competitive opportunities for individuals within dis-
ability-specific meets (although Special Olympics

includes some unified swimming events that provide
reverse inclusion of athletes without disabilities). Ath-
letes with dwarfism may participate as members of the
Dwarf Athletic Association of America (DAAA) in their
regional and national games, and swimmers who are
blind or visually impaired may participate in United
States Association of Blind Athletes (USABA) competi-
tions. These competitions are limited in number and
are usually located far away from a swimmer’s home
pool (Lepore, 2005).
Although swimming is the primary means of
aquatic competition in the disability sport world,
competitive diving and water polo are other options,
though they generally need to be pursued in inclusive
team settings.
Adapted, by permission, from M. Lepore, 2005, Aquatics. In Adapted physical education
and sport, 4th ed., edited by J.P. Winnick (Champaign, IL: Human Kinetics), 446-448.
Integrated Versus
Segregated Sport
Although the goal of classifying athletes in disability
sport has been to provide fair and equitable com-
petition, it continues to be controversial. As with
instructional aquatics, competition should be held
in the most inclusive setting possible. Indeed, school
and community competitive swim coaches should
consider recruiting and accommodating individuals
with disabilities. There is a need for a continuum of
opportunities for aquatics participation, and swim-
mers should be afforded options (Lepore, 2005).
Visionary coaches include athletes with disabilities
and benefit their club through heightened media
attention and by enriching life experiences between
athletes with and without disabilities.
When a school team is solely focused on elite ath-
letic performance, participation and skill development
of individuals with disabilities are ignored. Minnesota
was the first U.S. state to integrate a variety of students
with disabilities into the structure of the state high
school athletic association (Kozub & Poretta, 1996).
However, in 2001 the Georgia High School Associa-
tion (GHSA) set a national precedent when it named
the American Association of Adapted Sports Programs
(AAASP) its counterpart on behalf of students with
physical and visual disabilities. The GHSA recognizes
the AAASP as the governing and sanctioning body for
interscholastic adapted athletics in Georgia. Therefore,
AAASP became the United States’ first “organization
serving students with physical disabilities or visual
impairments to be recognized as the governing and
sanctioning body for interscholastic athletics on
behalf of a member of the National Federation of High
Schools (NFHS) (American Association of Adapted
Sports Programs [AAASP], 2005, p. 1).
Competitive and Recreational Activities 265
Project ASPIRE (Adapted Sports Programs In
Recreation and Education) is “the first nationwide
expansion of interscholastic adapted sports programs
to each state by making the resources and tools of
AAASP and its ‘Partners-in-Progress’ widely available
and easily accessible. The basis of Project ASPIRE
is to gain agreements to develop an interscholastic
athletic infrastructure parallel to traditional interscho-
lastic athletics through which new athletic programs
will spring up and existing programs will thrive”
(Project ASPIRE, 2005, p. 1). The goal is to promote
and solidify amateur adapted athletics by making
the educational, informational, and sport equipment
resources of Project ASPIRE partners available to
school systems and their community partners, as well
as to sport and education professionals.
In addition, Project ASPIRE strives to educate
swimmers without disabilities and their coaches
about the integrated team approach practiced by the
Minnesota Athletic Association (MAA) and Special
Olympics Unified Sports, both of which promote
inclusion in participation. They work to develop a
positive attitude toward diversity and point out how
proud participants with and without disabilities will
be when they work together to accomplish their
goals. Moreover, this approach meets the spirit of
the ADA, providing equal opportunity (Block, 1995),
and it expands the base of school pride by involving
individuals who are traditionally excluded.
However, participation in segregated sport programs
is not a last resort. Proponents of segregated activi-
ties believe that working with other individuals with
similar disabilities often best delivers independence,
self-esteem, and health-related fitness. In addition,
socialization and opportunities for persons with dis-
abilities in sport would not exist to the extent they do
without segregated DSOs. On the other hand, critics
of segregated programs state that people who partici-
pate in these programs are denied the opportunity to
interact with individuals without disabilities and that
participation perpetuates the stereotype of segregation.
Regardless of the mode of participation, the philosophy
of inclusion and integration remains a priority of the dis-
ability sport movement (DePauw & Gavron, 2005).
Disability Sport Organizations
Individuals with disabilities may compete in segre-
gated, integrated, or inclusive programs, including
school-based intramural activities, interscholas-
tic and intercollegiate sport opportunities, and
community-based amateur sport programs. Most com-
petitive swim programs for people with disabilities are
run in conjunction with rehabilitation centers, com-
munity sport clubs, or segregated residential or day
266 Adapted Aquatics Programming

schools, although many teens can compete on their
own high school and community teams. More serious
elite swimmers train with USA Swimming clubs. As
previously discussed, the organization of DSOs sig-
nificantly changed with the passage of the ASA, which
relegated them to the USOC community membership
category. The only case where DSOs still fulfill the Para-
lympic sport organization role is for disability-unique
sports—such as boccia—that aren’t part of the Olympic
movement for people without disabilities.
However, DSOs still offer grassroots programming
in the United States, and they coordinate with their
international counterparts for some world competi-
tions. For example, the National Disability Sports
Alliance (NDSA) is a member of the Cerebral Palsy
International Sports and Recreation Association
(CPISRA) and sends athletes to the CPISRA World
Games in Nottingham, England. Remember, U.S.
Paralympics now represents the United States in the
Paralympic Games. Therefore, since deaf and Spe-
cial Olympic athletes are not part of the Paralympic
family, the U.S. Paralympics essentially has no role
with these groups (G. Dummer, personal communi-
cation, May 19, 2005). Currently, DSOs serving the
interests of individuals with disabilities in sport and
athletic endeavors are the USADSF, Disabled Sports
USA (DS/USA), DAAA, Special Olympics, NDSA,
USABA, and Wheelchair Sports, USA. We’ll look
more closely at each of these organizations in the
following sections. See figure 12.2, which outlines
international and U.S. sport organizations.
USA Deaf Sports Federation
The USA Deaf Sports Federation began in 1945 as
the Akron Club of the Deaf and is the oldest DSO in
America. Approximately 25,000 individuals who are
deaf or hard of hearing participate in a multitude of
sports through some 2,000 clubs in the United States.
The criterion for participating is a hearing loss of 55
decibels or greater in the better ear (USADSF, 2005).
Although many multisport clubs exist, relatively few
deaf-only swim clubs have been established in the
United States, and all at schools for students who
are deaf. The USADSF is the U.S. affiliate of the
Deaflympics, formerly known as the World Games
for the Deaf, which are sponsored by the Comité
International des Sports des Sourds (CISS, also known
as the International Committee of Sports for the Deaf).
This Olympic-style competition is the showcase of
sports for people who are deaf and is held every 4 years
in the year immediately following the Olympic Games.
Swimming and diving events are conducted
according to USA Swimming rules, which allow arm
signals for starting swimmers who are deaf. There is no
separate junior or senior division and no classification
system except for separate male and female divisions.
The United States Aquatic Association of the Deaf
(USAAD) is the national sport organization affiliate
of the USADSF and handles queries about swimming
for people who are deaf (see appendix E).
Disabled Sports USA
DS/USA is a national organization providing opportu-
nities for children and adults with permanent disabili-
ties to participate in year-round sport rehabilitation
programs. Their motto is, “If I can do this, I can do
anything.” It was founded in 1967 as the National
Handicapped Sports and Recreation Association
(NHSRA) by Vietnam veterans and serves individuals
with physical disabilities that restrict mobility, such as

International Paralympic Committee

(IPC)

International Sports Cerebral Palsy International International International Wheelchair

Federation for Persons International Sports Blind Sport Committee of Sports and Amputee Sports
with Intellectual and Recreation Federation for the Deaf Federation
Disability Association (IBSA) (CISS) (IWAS)
(INAS-FID) (CPISRA)

National Disability United States USA Deaf Sports Wheelchair Sports, Disabled Sports USA
Sports Alliance Association of Federation USA (DS/USA)
(NDSA) Blind Athletes (USADSF) (WSUSA)
(USABA)

Figure 12.2  International and U.S. sport organizations.

E3344/Lepore/fig.12.2/278726/alw/r4

amputations, paraplegia, quadriplegia, cerebral palsy,
head injury, multiple sclerosis, muscular dystrophy,
spina bifida, stroke, and visual impairments (Disabled
Sports USA [DS/USA], 2005). Swim competition is not
a large part of the organization’s efforts, but DS/USA
does jointly sanction and cosponsor various cross-
disability training camps and swim competitions in
water sports, including adaptive paddling and water-
skiing (DS/USA, 2005).
Dwarf Athletic Association of America
Individuals with dwarfism and congenital short statures
participate in the DAAA, founded in 1985. The purpose
of the organization is “to develop, promote and provide
quality amateur athletic opportunities for dwarf athletes
in the United States” (Dwarf Athletic Association of
America [DAAA], 2005, p. 1). Participants must be 4
feet, 10 inches (1.5 meters) or shorter and classified as
dwarfs due to chondrodystrophy or other related causes
of short stature. Swimming is one of the major sports
offered at local, regional, and national competitions.
In national events, in which people with dwarfism are
segregated from swimmers with other disabilities, par-
ticipants are divided into a three-tiered classification
system for open events. This system is based on body
size, proportions, gender, and age.
The age range for the open division is 16 to 39 years,
although junior and master athletes may compete in
the open division if they choose. Athletes in the open
division may compete in junior or master division
events if they meet the age requirements. However,
athletes cannot compete in more than one division
per event. The junior division is for athletes between
the ages of 7 and 15. The division is divided into three
groups: ages 7 to 9, 10 to 12, and 13 to 15. Athletes
in the 13- to 15-year-old division may compete in
the open division, provided that classification into
the open system has taken place. If athletes wish to
compete in both the junior and open divisions, they
must register in the open division. Only limited events
are offered in the master division. Athletes must be 40
years old or older on the date of competition. Athletes
in the master division may compete in open events if
they register in the open division. The final division is
the futures. This is for youths who are less than 7 years
old and offers limited events, including swimming.
In competitions in which people with dwarfism are
integrated with people with other disabilities, such as
the Paralympics and other international competitions,
organizers use an integrated swimming classification
system.
Special Olympics
The first Special Olympics competitive swimming
event was held in Chicago in 1968 (see also chapter
Competitive and Recreational Activities 267
1). Today, Special Olympics competitions include
30 official events, 25 of which are Olympic-type
events, qualifying athletes for national and interna-
tional competition. The swimming events include 50
meters of the four competitive strokes, a variety of
individual medley events, and freestyle and medley
relays. Athletes with severe limitations may participate
in one of five events, including 25 meters of one of
the two competitive strokes, a 15-meter walk, a 25-
meter flotation race, a 10-meter assisted swim, and
a 15-meter unassisted swim.
Each event is separated into divisions, and heats
are developed according to age, gender, and ability
level. To make competition more equal, the most
crucial criterion for dividing athletes in a heat is
the 10% guideline: Variance between the highest
and lowest swim times (or scores in diving) should
not differ by more than 10% (Special Olympics,
2004b). Some events are coed, although organizers
are encouraged to plan gender-segregated heats as
long as there are enough competitors. The official
age groupings are 8 to 11, 12 to 15, 16 to 21, 22 to
29, and 30 and over.
To help you brainstorm ways to adapt aquatics
for competition in your program, we have taken the
following examples of some rule modifications from
the Official Special Olympics Summer Sports Rules
(2004b):
• Flotation devices during the flotation races must
be secured on (wrapped around) the athlete
and may not be an item that is held, such as a
kickboard or foam noodle.
• Walking events should take place in water no
more than 3.5 feet (1 meter) deep, and the
athlete must keep one foot touching the pool
bottom at all times.
• During the assisted swim events, athletes must
provide their own assistant. The assistant may
not support or assist in forward movement;
only touching, guiding, or directing the athlete
is allowed.
In the Special Olympics, diving has four levels,
with different levels of competency assigned to each
category. For example, athletes participating in level
1 diving competition must be capable of performing
two dives, level 2 requires three dives, level 3 requires
four dives, and level 4 requires five dives. Fédération
Internationale de Natation (FINA) rules for senior
competition apply.
In addition to Special Olympics segregated com-
petitive swim programs, Unified Sports team par-
ticipation is available, in which athletes with mental
retardation and partners without mental retardation
268 Adapted Aquatics Programming
train for competitive swimming on the same team.
Considerations for starting a team include having
participants of approximately the same age and abil-
ity; ages should be within a 3- to 5-year age span for
athletes under 21 and within a 10- to 15-year age
span for swimmers aged 22 and older. In addition,
opportunities exist for noncompetitive instructional
teams to which these age ranges may not apply.
Unified Sports, a registered program of Special
Olympics, combines approximately equal numbers
of athletes with mental retardation and athletes
without mental retardation to train and compete
together on sport teams, including swim teams.
During training, the partners should train together,
but the partner without disabilities should not be
given the role of coach since it is a team with equal
status given to all members. Experienced coaches
have found that siblings and other relatives of Special
Olympics athletes make good Unified Sports swim
team members.
United States Association of Blind Athletes
USABA was established in 1976 as an organization
whose mission is to ensure that legally blind athletes
have the same opportunity in sport that people with
sight have. USABA divides competitors into four
classes according to degree of vision and according
to four age groups: open (any age), youth (8-13),
masters (30-49), and people aged 50 or older. USABA
publishes a swimming rules book, available through
its national office, which modifies USA Swimming
rules (United States Association of Blind Athletes
[USABA], 2005). For national competition, USABA
prefers 50-meter pools, which reduce the need for
turns; it also recommends a modified swim turn.
Other modifications that USABA sanctions include
the following:
• Coach tapping a swimmer to indicate a turn or
the finish line*
• Speaking to swimmers if they drift into the
wrong lane
• Hanging continuous ribbon low enough to
touch, lowering the backstroke flags, using
bubbling devices, or showering water from the
backstroke flags (although these are suggested,
the USABA Swimming Sports Technical Com-
mittee must approve them)
• Giving swimmers the option of starting on the
diving blocks, the pool edge, or in the water*
• Coach giving a deafblind athlete a starting
signal*
• Coach or another swimmer starting any relay
participant with a nonverbal signal, such as
touching*
• Giving totally blind swimmers some leeway in
touching the wall with hands on the same level
for breaststroke and butterfly
*These items are already sanctioned under USA Swimming
rules.
National Disability Sports Alliance
The first national program in competitive sports for
individuals with cerebral palsy began as the National
Association of Sports for Cerebral Palsy (NASCP) in
1978. In 1987, the administrative component of the
organization was restructured and the organization
broke away from its parent group, the United States
Cerebral Palsy Association, and became the United
States Cerebral Palsy Athletic Association (USCPAA),
an independent association. In 2001 the association
changed its name to the National Disability Sports
Alliance. The organization supports athletes who have
cerebral palsy or traumatic head injuries or who have
had a stroke. The NDSA provides swimming competi-
tions and other athletic events through local, regional,
and national organizations and in conjunction with
other international organizations. The international
federation is the CPISRA. The CPISRA is a member
of the International Paralympic Committee (IPC).
The NDSA follows the IPC’s functional classification
system (IPC, 2005). Physical therapists and adapted
physical educators who are trained in the classifica-
tion system evaluate the functional ability of athletes
and the quality of their performance in swimming.
More on classification is included later in this chapter.
The IPC Swimming Handbook is an important refer-
ence to have when training athletes with cerebral
palsy; you may obtain it through the IPC Swimming
Web site (see appendix E).
Wheelchair Sports, USA
Formerly the National Wheelchair Athletic Asso-
ciation (NWAA), this organization has roots in the
mid-1940s, officially becoming the NWAA in 1956.
Wheelchair Sports, USA (WSUSA) generally serves
individuals with spinal lesions, although it does serve
other individuals with mobility impairments, such
as people who are missing limbs. U.S. Wheelchair
Swimming, Inc. is a subsidiary of WSUSA that con-
ducts competitions in conjunction with USA Swim-
ming and advocates swimming competitions and
training programs. U.S. Wheelchair Swimming clas-
sifies participants according to gender and age (junior

and senior), and for international meets, it uses the
integrated, functional classification system. WSUSA
uses USA Swimming rules, which allow for various
starting positions for starts, turns, and strokes.
The IPC Swimming Classification Manual governs
competitors in games held under U.S. Wheelchair
Swimming patronage (Dummer, 1999). The classi-
fication system is discussed under Functional Swim
Classification Components on page 270.
Equitable Competition and
Classification
Equitable classification has long been a challenging
component of disability sport, especially in interna-
tional competition. Classification in disability sport
organizes athletes into groups by some set of criteria
for structuring competition. Dummer (2003b, p. 1)
explains that “classification systems used in dis-
ability sport generally focus on one or more of these
variables: (a) the nature and severity of the athlete’s
disability; (b) the athlete’s functional ability to perform
skills associated with the sport; and/or (c) the athlete’s
performances in previous competitions.” Following
are various classification systems.
• Medical. In a disability-specific (medical)
classification system, classifications are based on
anatomical differences in the human body, and ath-
letes compete against other athletes with the same
disability. Someone with medical education typi-
cally conducts diagnosis or classification. Examples
include measuring vision loss of athletes who are
blind and measuring residual limb length for athletes
with amputations. Disability-specific classification
tends to be more precise and objective than other
methods are; however, the anatomical difference that
is being measured may or may not have a significant
effect on sport performance.
• Functional skills. Functional classifications are
based on what participants can and cannot do in a
particular sport or in a group of sports that require
similar skills. For example, swimmers in Paralympic
competition are classified primarily by swimming
skills. Although joint mobility, coordination, and
strength are tested, only swimming points count in
determining classification. Persons who are expert in
the sport typically conduct classification; however,
their judgments are often supplemented by the obser-
vations of others who have extensive knowledge of
disabilities.
Competitive and Recreational Activities 269
• Sport performance. Performance-based (func-
tional) classification systems use the athlete’s previous
best times or performance data as the basis of classi-
fication. For example, the Special Olympics program
groups athletes according to recent previous perfor-
mances, with not more than a 10% difference in the
times or performance levels of athletes in a particular
event (Dummer, 2003b). This practice is intended to
create fair and equal competition by accounting for
differences in body functioning, muscle mass, body
proportion and size, and body weight. The Special
Olympics performance-based classification system is
intended to provide a means by which all swimmers
in an event have equal possibilities of becoming a
winner.
Indeed, for some individuals with disabilities,
such as the most disabled, competition would lead
to constant failure unless a grading or classification
system existed. Furthermore, without classification,
the competition might be very unequal due to the
wide range of abilities associated with each disability
group.
Medical Versus Functional
Classification
Organizations train classifiers who classify par-
ticipants under either a disability-specific (medical)
system, where athletes have similar disabilities, or
a sport-specific (functional) system, where athletes
have similar functional abilities but different dis-
abilities. Unfortunately, when an athlete is classified
by disability without regard to the sport in which she
will participate, little consideration is given to the
demands of the sport. We believe that different cat-
egories should exist that are based on sport demands,
such as events in which participants propel their
wheelchair versus aquatic events in which a person
cannot use mobility devices, as in those sponsored
by the National Disability Sports Alliance.
Before the 1980s, U.S. DSOs and some interna-
tional DSOs used segregated classification systems
based on specific medical diagnoses and levels and
sites of injury or disability. In the mid-1980s and
early 1990s, leadership within the IPC fostered the
development of a system placing greater emphasis on
sport performance (functional). Following the 1988
Seoul Paralympics, DSOs exhibited less autonomy
and moved toward eliminating their medical clas-
sifications in favor of the integrated functional clas-
sification system. This system integrates people with
a variety of disabilities into a single event or heat,
basing criteria on the function of the individual
270 Adapted Aquatics Programming
(Vanlandewijck & Chappel, 1996), including factors
such as strength, quality, and quantity of active muscle
mass and performance within a specific sport (Ferrara
& Davis, 1997).
Swimming and the Functional
Classification System
In 1992 the Paralympic Games for athletes with physi-
cal and visual disabilities were held in Barcelona.
The Paralympic Games for athletes with intellectual
challenges, which included athletes from what was
then called the International Sports Federation for
Persons with Mental Handicap (ISFPMH), were held
the same year in Madrid. (The ISFPMH is now called
the International Sports Federation for Persons with
Intellectual Disability.) Since 1992, the Paralympic
Games have had a division for people with intellec-
tual challenges in each competition except the one in
Athens, where the team from Spain was suspended for
using athletes classified as intellectually challenged
who were later found not to have such disability. This
resulted in the expulsion of athletes who competed
under the auspices of the ISFPMH (DePauw & Gavron,
2005, p. 249).
Functional Swim Classification Components
The integrated functional classification for swimming
was extensively studied by Blomgwist of Germany
and Williamson of England in the early 1980s and
later modified by the IPC (Sherrill, Adams-Mushett,
& Jones, 1986). Classification in swimming attempts
to place individuals with disabilities into groups of
comparable ability and function. International Para-
lympic competition is not designed for all, just as
the Olympic Games exist for the truly elite athlete
(IPC, 2005). Currently, a group of individuals who
are trained as swimming classifiers examines each
athlete who has locomotor impairments before each
meet. The IPC Swimming Handbook (2005) identi-
fies the following three-step classification process.
In addition, it cautions that an individual swimmer’s
classification is ultimately determined by the point
value earned on swimming tests, and not by class
profile description. The process is as follows.
1. Bench testing, which includes one or a com-
bination of four tests:
a. Manual muscle test
b. Coordination test
c. ROM test of major joints
d. Measurement of limb length or total body
height
2. Observation in the water
3. Observation during competition. A swimmer
can have up to three classes, and classes are
determined by the following strokes:
– S1-S10 for freestyle, backstroke, and butterfly
– SB1-SB9 for breaststroke
– SM1-SM10 for individual medley. (For specific
information on the individual medley, see the IPC
Swimming Handbook [2005].)
What does this series of letters and numbers mean?
The prefix S denotes the class for freestyle, backstroke,
and butterfly; SB is for breaststroke; and SM is the
class for individual medley. The numbers after the
letters range between 1 and 14. The numbers 1 to
10 pertain to the classes allocated to swimmers with
physical disabilities, 11 to 13 are allocated to swim-
mers with a visual disability (S11 is a swimmer with
no sight and S13 is one with sight restrictions), and 14
pertains to swimmers with an intellectual disability.
For physical disabilities, there is also a range from
swimmers with severe disability (S1, SB1, SM1) to
those with minimal disability (S10, SB9, SM10).
Administrative Benefits and Burdens
The debate over the integrated functional classifica-
tion system has essentially disappeared among expe-
rienced swimmers; however, parents of novice swim-
mers continue to be critical. The proponents of such
a classification system believe that its administrative
benefits outweigh any problems. This classification
system simplifies the administration of a competi-
tion by reducing the number of events (G. Dummer,
personal communication, May 19, 1997). Moreover,
with the functional classification system in place,
enough competitors participate in almost every event,
resulting in true competition. The primary controversy
involves the small number of competing swimmers
with severe disabilities rather than the classification
system itself. There is an IPC rule stating that there
must be 10 swimmers from six nations in order to hold
an event. While this IPC rule may seem unfair, the
traditional classification system was more confusing.
Before the functional system, the immense number of
classifications resulted in too few competitors in each
event heat, resulting in confusion to the general public
and sports media regarding who the true champions
within each event were. For example, before the
functional system, the 100-meter freestyle may have
had 50 or more winners at a swim meet in which each
DSO used its own classification system.
People opposed to functional classification have
argued that swimmers are sometimes reclassified
during a competition, adding to administrative bur-
dens. Specifically, reclassification can waste time,
wreak havoc on seeding and organization, and disrupt

schedules at the last minute (Richter, Adams-Mushett,
Ferrara, & McCann, 1992). However, in our experi-
ence these same issues plagued the traditional medi-
cal classification systems, due to inconsistency among
state, regional, and national examiners’ and athletes’
misrepresentation of their true ability. In addition,
we believe that such administrative difficulties and
classification ambiguities will ease once all parties
become more familiar with the system.
Difficulty in Accurately Classifying Function
Of course, the swimmers themselves have had much
to say about the classification debate. In some swim-
mers’ opinions, administrative convenience and
preferences of the sports media and general public do
not justify the decision to move to a functional clas-
sification system. These swimmers argue, for example,
that some competitors with cerebral palsy and com-
petitors with more severe physical disabilities may
have underlying neurological issues that sometimes
appear and sometimes do not appear during the clas-
sification process. Consider primitive reflex retention,
in which early infant reflexes may still be present in
an athlete with cerebral palsy. Although such athletes
may outwardly function similarly to swimmers with
amputations, once the starting signal goes off, the
startle reflex may impair their movements, but not
those of athletes with amputations who are in the
same classification. If a classification system is fair,
performances across classes should be different, and
elite swimmers in the same class should have equal
opportunities to advance.
Worries About Elitism
Another concern about the functional classification
system that some swimmers and athletes with physical
disabilities in all venues of sport present is the notion
of elitism. Disability-specific aquatic competitions
and classifications fostered a large number of group-
ings and heat events so that athletes of all levels could
participate. Eliminating events generally reduces
the number of events available for more severely
disabled athletes. Some people think the functional
classification system, which integrates all disability
groups, is an attempt to provide elite athletes with
the opportunity to display their talents in order for the
disabled sport movement to move toward a so-called
authentic sport movement. Shepherd indicates that
using the functional classification system is “moving
away from the rehab model into an era of true elite
athleticism” (Kaminker, 1996, p. 63).
Some people maintain that the functional system
favors athletes who are the least disabled and the most
skilled. Therefore, athletes with traumatic brain injury,
for example, experience rejection due to neurological
Competitive and Recreational Activities 271
manifestations that prevent the same type of physical
performance as that demonstrated by athletes with
amputations, spinal cord injuries, or dwarfism. Some
say integrated classifications will have a greater effect
on the audience by portraying only the most “able”
disabled, who present an image of ability that is
more analogous with typical Olympic competition.
Athletes with more severe disabilities feel that the
more elite athletes with disabilities are embarrassed
to compete at the same games as them (Kaminker,
1996). The IPC convened a task force in response to
these opinions, and in the 1996 Paralympic Games,
the classification system was revised to make it more
equitable to swimmers with cerebral palsy.
In an effort to determine whether functional clas-
sification systems result in fair competition between
athletes with different impairments, investigators
have conducted empirical research. Wu and Wil-
liams (1999) examined athletes at the 1996 Atlanta
Paralympics by analyzing the relationship between
swimming performance and classification, as well as
the relationship between impairment and swimming
performance. They concluded that the functional
classification system was generating fair competition
for most athletes.
In addition, Daly and Vanlandewijck (1999) con-
ducted a performance analysis to evaluate the fairness
of functional classification systems by comparing
swimming performance data for the freestyle and
breaststroke to IPC individual athlete world rank-
ings. Their conclusion was that fairness existed using
a functional classification system, with exceptions
mostly stemming from a lack of sport maturity.
Nonetheless, at local, national, and international
levels, the classification debate goes on, fostering
strong emotions. Such debate is healthy and typical
of any organization that continues to grow; however,
functional classification remains an important com-
ponent of competition for individuals with physical
disabilities.
Special Olympics and
Classification
Classification in world-class events for athletes with
intellectual disabilities is quite different from the
integrated functional classification system used by
the IPC. First, to participate in Special Olympics
competitions, athletes must verify intellectual dis-
ability and meet qualifying standards. The 2004-2007
edition of the Official Special Olympics Summer
Sports Rules (Special Olympics, 2004b) governs all
aquatic competitions. As an international sport pro-
gram, Special Olympics has created these rules from
the FINA and NGB rules for aquatics. FINA or NGB
272 Adapted Aquatics Programming
rules are employed except where they are in conflict
with the Special Olympics sport rules. In such cases,
the Special Olympics rules apply. The rules divide
competitors according to age, gender, and ability.
Athletes submit their best times for an event, and then
organizers seed them into divisions according to the
10% rule (i.e., within a division, an athlete can have
no more than a 10% difference between the top and
bottom times for the event).
Paralympics for Persons With
Intellectual Disability
A complementary organization to the Special Olym-
pics at the international level has been the Interna-
tional Sports Federation for Persons With Intellectual
Disability (INAS-FID), begun in 1986. The INAS-FID
is a founding member of the IPC and currently has
87 national member organizations (one per country)
(International Sports Federation for Persons with Intel-
lectual Disability [INAS-FID], 2005). The INAS-FID
eligibility for all international levels of competition
in which athletes with intellectual disability compete
is as follows:
• Minimum age requirement for international
competition as set by the international sport
governing body (e.g., FINA)
• Intellectual disability formally diagnosed in
accordance with accepted standards endorsed
by international authorities in this area
• Evidence of the effects of the intellectual dis-
ability in sport
In addition to these criteria, sport-specific perfor-
mance standards (for example, meeting a qualifica-
tion time) may also exist in some international com-
petitions (for example, IPC World Championships)
(INAS-FID, 2005).
In comparison, for athletes to participate in Special
Olympics Games, they must train in swimming at
least 8 weeks; place first, second, or third at national
competitions in their division; and be at least 8 years
old.
Coaching Swimmers With
Disabilities
Athletes with disabilities are often deprived of com-
petitive swim opportunities due to the lack of empa-
thetic, knowledgeable coaches. Although training
techniques are similar, coaching knowledge about
specific disabilities is important to the success of
the athlete. Many times, individuals with disabilities
take longer to progress, and far too often parents and
coaches who are not experienced with coaching the
disabled become discouraged by the minimal prog-
ress that takes place in one swim season (Mushett,
Wyeth, & Richter, 1995). Thus, swimming profes-
sionals should take advantage of coaching clinics to
learn the nuances associated with disabled sport. For
starters, athletes should not be allowed to attempt
competition unless they have mastered basic swim
skills, attained some endurance, and developed a
positive attitude toward competition. Initial training
should focus on slow, quality movements rather than
on swimming as fast as possible. Initially, it is OK to
allow an athlete to use flotation devices; however,
phasing the devices out will enhance progress toward
independent swimming. Coaches should focus on
the stroke or the position in which the individual is
most comfortable, whether prone or supine. Then
they should develop this strength before introducing
another stroke, concentrating on sound individual
functional mechanics rather than on traditional stroke
techniques.
Responsibilities
The task of inclusion is a daunting one; however, the
coach must take a strong philosophical stand sup-
porting the inclusion of swimmers with disabilities
on a team of swimmers without disabilities. One
of the most difficult challenges is the attitude of all
involved, including parents of the swimmers without
disabilities. However, everyone involved can learn to
focus on ability rather than disability and on shared
goals and training regimens.
If the entire team consists of participants with dis-
abilities, the coach will face the unique challenge of
developing a team that may consist of very diverse
swimmers, such as individuals with congenital dis-
abilities (e.g., spina bifida) or traumatic injuries (e.g.,
automobile accident) or war veterans with disabilities
(e.g., amputation). In addition, there will be wide
variance in age, life experience, athletic exposure,
confidence, and personal goals. The complexities
of this experience are many and the success of the
team will be determined by the coach’s leadership,
especially early in the experience. Coaches of such
teams should enhance their communication skills and
teaching of sport techniques, and they should modify
activities and equipment (USA Swimming, 2001).
Coaching athletes with disabilities is both an
art and science, challenging coaches regardless of
inclusive or segregated athletic venues. Although

inclusion can be mandated, friendship cannot. When
coaching in an inclusive setting, remember that there
are two types of inclusive behaviors. The following
types of inclusion are modified from Sherrill and
Tripp (2004b).
The first is instructional inclusion, which refers to
the athlete with a disability practicing with swimmers
without disabilities in the general practice session.
Instructional inclusion depends on the similarity
of the events and strokes of the swimmers and the
extent of resources to support inclusion. If events
and strokes are significantly different, an assistant
coach or volunteer can assist the swimmer with the
disability in lanes without the other teammates and
provide social interaction.
The second type of inclusive behavior is social
inclusion, which refers to positive interactions among
teammates that contribute to feelings of accepting
and liking each other. The coach must guard against
unidirectional interactions in which swimmers
without disabilities initiate most of the contact and
view themselves as helpers. Instead, coaches should
promote equal status, where both parties reach out
to include each other. Remember, individuals with
disabilities often define good days as those where
they experience accomplishment and a sense of
belonging, whereas bad days are defined by ques-
tionable competence and social isolation. Coaches
who foster positive, inclusive aquatic experiences do
the following:
• Incorporate the team concept with everyone
• Effectively use coaching cues
• Respond to different learning styles
• Help others develop social skills
• Eliminate stereotyping
If you choose to coach, you will have responsi-
bilities for your athletes with disabilities and you
should maintain high standards for yourself and your
swimmers. Priority tasks include getting to know the
athletes, focusing on ability rather than disability,
and meeting with the swimmers to discuss their abili-
ties and goals. You should read about each athlete’s
particular disabilities and make an assessment by
comparing the athlete’s performance to a standard
of functional ability. Also, you should demonstrate
the same general expectations as those established
for swimmers without disabilities. Specifically, your
initial expectations of the athletes should include
complying with team rules, demonstrating a good
work ethic, supporting teammates, helping with
team activities, and attending team social functions.
Competitive and Recreational Activities 273
The main goal is the improvement of swimming
performance through appropriate instruction and
feedback, as well as strength, flexibility, and endur-
ance training.
A coach also needs to learn what modifications
are possible, helpful, and legal for swimmers with
disabilities, preferably through formal coaches’ train-
ing. You should become a member of your athlete’s
organization in order to keep up with modifications
and event announcements. Then, you should become
familiar with the rules and classification systems the
swimmer will need to comply with through the IPC,
DSO, and USA Swimming rule books. DSOs, univer-
sities, and national professional organizations (e.g.,
USA Swimming) conduct training clinics, maintain
coaches’ professional records, and distribute manage-
ment guides for conducting swim training and other
athletic events. As a coach, you must be willing to
get in the water with an athlete to demonstrate and
physically manipulate the athlete in order to facilitate
better communication.
Coaching Certification and
Training
A coach must be aware of the physical, psychological,
and social challenges of a permanent disability on
athletes with disabilities and their family members.
Such challenges to the athlete and the family require
a certified coach with aquatic skill knowledge and the
interpersonal skills necessary to function in a diverse
environment. Three coaching certification or training
organizations that help develop such coaches are the
American Swimming Coaches Association (ASCA),
Special Olympics, and USA Swimming.
A coach desiring ASCA certification needs to have
three things analyzed in the certification process:
education, experience, and achievement. The certi-
fication indicates that the coach has met the required
standard at each level. The five levels become increas-
ingly more difficult. Level 5 is composed of the top
2% to 5% of coaches in the United States. Level 4 is
the top 5% to 8%, and level 3 is the upper 15% of
coaches. Level 2 requires more education and expe-
rience than level 1 (American Swimming Coaches
Association [ASCA], 2005). To become a USA Swim-
ming coach, a person must adhere to Article 502.4.3
of the USA Rules and Regulations (USA Swimming,
2005). This article states the following:
All coaches of USA Swimming clubs, including
seasonal clubs, shall join USA Swimming as coach
members and shall satisfactorily complete safety and
training required by USA Swimming. (p. 117)
274 Adapted Aquatics Programming
Before registering as a coach for USA Swimming,
an individual must have the following safety certifi-
cations:
• CPR
• First aid
• Safety training for swim coaches
In addition, Special Olympics provides a DSO
training program for coaches. The current Special
Olympics Coaches Education System was developed
to meet the needs of both new and experienced
coaches. To become a Special Olympics coach, a
person must do the following:
• Attend a Special Olympics general orienta-
tion.
• Participate in an approved course.
• In most cases, complete a minimum of 10 hours
of teaching and coaching Special Olympics
athletes.
• Complete the Special Olympics Application
for Sports Training Certification and submit it
to the local Special Olympics program (Special
Olympics, 2004b).
Upon completion, the individual is eligible for
certification; however, education and certification are
viewed as an ongoing experience. Having the neces-
sary aquatic certification should provide the coach
with an educational baseline sufficient for assuming
the responsibilities of a coach. However, the coach
will be exposed to unique situations and should be
willing to seek additional professional advice when
necessary.
Training Tips
Competitors who are not elite athletes often do not
enjoy excellent facilities or intensive training from
experts in competitive swimming. Many times,
coaches are rehabilitation specialists, family, or
friends. However, athletes are primarily interested
in coaches who are experts in swimming and care
about them as people (G. Dummer, personal com-
munication, May 19, 1997). Training in coaching
swimming is the most important background for
a coach of individuals with disabilities, but it is
extremely wise for the coach to attend clinics, view
videos, and read articles pertaining to specific dis-
ability implications.
Individuals with disabilities traditionally do not
have the opportunities that individuals without
disabilities have to participate in interscholastic
or intramural sports; therefore, they have sporadic
training regimes, which may consist of only one 2-
hour training session a week, culminating 8 weeks
later in a state or local meet. This is hardly the ideal.
Year-round training to maintain some level of fitness
is paramount in developing an active lifestyle and
improving quality of life. As disabilities and athletes
vary widely, no singular formula for training exists.
Refer often to this chapter and the teaching tips and
safety issues in chapter 9 as an important first step to
training swimmers with disabilities.
Before Training
Before beginning training, find out what type of
functional abilities the athletes have through talking
informally to them and their caregivers and through
a more formal assessment of problems with memory
or lower-body disability. Look up the disability,
learn about the possible attributes that may impair
function (see table 9.1 on page 191), and read the
corresponding material regarding those concerns.
Then put together a swim plan incorporating the
information you have gathered and the goals the
swimmer has set.
Setting Goals
Teaching swimmers with disabilities how to set goals
empowers them to exercise control over their future.
In fact, goal setting is the most critical component of
competition, and without it, the coach and swimmers
can lose focus (Davis & Ferrara, 1995). When setting
goals, both swimmer and coach need to examine the
current swim skills and fitness of the athlete, the time
commitment that will be necessary for training, the
pool and other training space in an available facil-
ity, and the length of time needed to accomplish the
goals. As swimmers reach goals, the coach should
work with them to set new goals. If swimmers do
not reach their goals after given ample time to do so,
help them task-analyze the goals into simpler, more
discrete components.
Developing a Progressive Training Program
Apply the principles of general swim training to
develop a progressive training program that considers
the swimmer’s goals, medical indications or contra-
indications, present level of swimming performance
and fitness, and anatomical limitations. In addition,
analyze the event in which the swimmer will com-
pete, taking into account the principle of specificity of
training. For example, if the swimmer is competing in
sprints, the training program must help him develop
strength, power, and anaerobic performance for short
distances. Moreover, incorporate the principles of
FITT (frequency, intensity, time, and type; see chap-
ter 10, page 235) to apply the overload principle.

Have the swimmer keep a training log, recording
workouts and anecdotal notes on soreness, spastic-
ity, and fatigue experienced during and the day after
a workout.
Legal Strokes, Starts, and Turns
Emphasize balanced body positions in the water.
Athletes with disabilities often experience difficulty
in achieving horizontal alignment and demonstrate a
lack of neck flexibility (Dummer, n.d.). Development
of some specific skills—for example, turning—will
require more of the swimmers’ time. A significant
concern is adjusting the swim stroke to fit the capabili-
ties of the individual while keeping the stroke legal
from a judge’s point of view. But turns and starts can
be the most difficult part of training. As a coach, you
must decide how to deal with strokes, starts, and
turns, based on what the rules say and what functional
ability an athlete has. For explanations of legal starts,
strokes, and turns, refer to USA Rules and Regulations
(USA Swimming, 2005).
Starts
Should the person start on the starting blocks? If the
athlete has good standing balance and can perform a
shallow dive or has good sitting balance, the answer
Photo courtesy of USA Swimming
Figure 12.3  An amputee’s experimentation with various
standing positions results in successful starts.
Competitive and Recreational Activities 275
is yes (see figure 12.3). If the athlete has good sitting
balance but no leg strength, a sitting dive from the
pool deck is also appropriate. If a sitting dive is not
appropriate due to poor trunk or head control or
high muscle tone, starting in the water is appropriate.
Swimmers who cannot grasp the wall and need to start
in the water can have someone on deck hold them
at the wall and then let them go at the start without
giving a push-off advantage.
Turns
Swimmers with mobility impairments may not have
the ability to push off with their feet, legs, or hands.
Swimmers with one leg or hemiplegia may have
difficulty coming straight off the wall and may need
to adjust the foot on the wall or the hand and body
position before the push-off. Elite athletes with one
functioning leg learn to compensate for the missing
limb. Keep in mind, however, that swimmers who are
classified as not able to use their legs for push-offs
cannot use them at all—even if they have some leg
strength. Become aware of any legal, useful move-
ment for a push-off, whether it is a single-joint (ankle
only) or hand and arm action. Often, when people
with paraplegia or quadriplegia approach the wall to
turn, they begin their turn before the wall and push off
at an oblique angle to provide propulsion to complete
the turn, similar to rounding first base in baseball.
Specifically, they push off with the pad portion of
the palm of one hand and lean one shoulder on the
wall, quickly moving their head toward the lane they
are swimming in.
Stroke Mechanics
Concerns about stroke mechanics and propulsion
exist in swimmers with impairments to trunk, hip, and
leg function. These swimmers, such as people with
spina bifida, spinal cord injuries, or polio, may have
intense arm power with no power in their legs, which
may cause stroke imbalance or excessive swaying of
the hips and legs or both. This affects hydrodynamics,
causing drag and poor streamlining. Lack of leg power
can also be a problem for swimmers who are doing
the breaststroke or butterfly. In the beginning of train-
ing, you can walk backward in front of a swimmer to
cut a path in the water, allowing the athlete to propel
herself more easily by reducing water turbulence
(Scull & Athreya, 1995; Sherrill & Dummer, 2004).
Many factors can impair balance, making breathing
difficult: excessive body roll, swaying of hips and legs,
uneven muscle control, and problems with buoyancy
due to muscle atrophy or limb loss. To compensate,
swimmers with one functional leg might kick that leg
inward and downward, crossing over midline, help-
ing balance the body and making breathing easier. It
276 Adapted Aquatics Programming
may also be helpful to perfect a two-beat kick in this
situation (for front crawl). To help build the strength
necessary to perform stokes correctly, you can allow
a swimmer to wear a flotation device or weight belt
during the initial stages of training, but not in major
competitions. Tethered swimming is another option
because it keeps the swimmer close to the edge of
the pool, making feedback easy due to the proximity
of the instructor. Tethering makes swimming in place
possible; simply attach surgical tubing or other elastic
cord to a belt worn by the swimmer and tie the other
end to the pool wall. Tethering also provides needed
resistance for persons with cerebral palsy, stroke, or
traumatic brain injury. In addition, emphasize to your
athletes the benefits of experimenting with various
training adaptations to fully use any remaining func-
tion they have.
Recreational Aquatic
Activities
U.S. federal legislation has empowered individuals
with disabilities to participate not only in traditional
swimming programming but also in adventure rec-
reation and sport activities. The ATBCB sets rules on
the accessibility of recreational facilities (e.g., boat
docks and fishing piers) in order to eliminate archi-
tectural and programmatic barriers (Architectural and
Transportation Barriers Compliance Board, 2004).
Individuals with disabilities have proven that they
have an inalienable right to take controlled risks and
that they can be safe and successful consumers of
recreational aquatic opportunities. Individuals of all
ages with disabilities enjoy water sports as much as
people without disabilities enjoy them, and water
sports provide outlets that allow them to recreate with
their peers, families, and community members. In the
following sections, we expand on how these activities
can serve as avenues for increasing independence
and normalizing existence.
Waterskiing
Waterskiing continues to be a rapidly growing aquatic
sport. USA Water Ski (USAWS) is the NGB in the
United States, and USAWS acknowledges the Water
Skiers with Disabilities Association (WSDA) as the
national DSO. This has led to the establishment of
the U.S. Disabled Water Ski Championships, and in
1993 the United States first participated at the World
Disabled Water Ski Championships. Other aquatics
associations and facilities, including the Mission Bay
Aquatic Center (see appendix E), promote the sport,
improve skiing technique, and advance equipment
design. With adequate instruction and equipment,
this activity gives an individual with disabilities the
opportunity to participate in a popular recreational
activity alongside family and friends.
Safety
Prerequisites to skiing include consulting with a
physician, awareness of hypothermia, and recogniz-
ing the limitations that a person’s level of sensation
and muscle function may dictate. The WSDA offers
workshops on safety precautions for the skier and
provides coaching techniques in their Adaptive Water
Skiing Coaching Manual (Bowness, 2006). Of course,
participants with disabilities need to observe the same
general safety precautions as participants without
disabilities observe. Possessing basic swim skills and
knowing how to use a personal flotation device (PFD)
are essential. All skiers should practice using a PFD
that meets their needs for support and buoyancy in a
controlled environment before using a PFD in open
water. In addition, skiers should be knowledgeable
of state and local regulations regarding waterskiing.
The driver of the boat, the observer, and the skier
should be thoroughly familiar with auditory boat horn
signals and verbal commands or hand or head signals
in order to make this a safe activity for all.
Equipment and Technique
To make skiing easier for the beginner and those
with disabilities, equipment modifications must be
made, especially for individuals with lower-extremity
involvement. A ski bra is one piece of equipment that
keeps the skis together for people with leg weakness
or paralysis. A specially designed sit ski can accom-
modate the skier who cannot stand up (see figure
12.4). A popular sit ski is the Kan Ski, available through
Access to Recreation at www.accesstr.com. These sit
skis feature molded seat backs, an aluminum seat
tube or cage, and quick-release tow rope attachments
and foot bindings on a wide- or regular-width ski.
Currently, sit skis are only manufactured by Quickie
Designs (Paciorek & Jones, 2001). After a significant
amount of practice, skiers who use the sit ski learn to
lean to one side or the other in order to change direc-
tion. Participants with visual impairments may use a
Mark 5 Bat Blaster from the British Disabled Water Ski
Association (BDWSA). Through the use of an audible
buoy that is attached to the boat, a sound is given that
cues the skier to begin turning and another sound is
given when the correct radius for the buoy has been
obtained (Paciorek & Jones, 2001).

Figure 12.4  Sit-skiing is an appropriate accommodation.
Scuba Diving and Snorkeling
Traditionally, scuba diving was not a sport open to
individuals with disabilities, but it has become part of
a nucleus of adventure-based water activities offered
to individuals with numerous disabilities. These are
activities that participants with disabilities can share
with participants without disabilities with only minor
modifications.
Before beginning training, the instructor and
diver need to discuss specific water access and entry
techniques from the pool, beach, or boat (Petrofsky,
1995; Robinson & Fox, 1987). Once in the water,
however, no architectural barriers prevent interac-
tion with nature and there is little gravity to restrict
mobility. Individuals with disabilities, accustomed
to being creative in everyday life to work their way
around physical and attitudinal obstacles, simply
carry this ingenuity into their dive plans and equip-
ment problems; “success is pragmatic and limited
only by human ingenuity” (Jankowski, 1995, p. 89).
As an aquatics instructor, collaborate with individuals
with disabilities to help them access the underwater
world through the technology available within the
scuba world.
A wide variety of scuba training programs are avail-
able that share the goal of diver certification, such
as the National Association of Underwater Instruc-
tors (NAUI), the Professional Association of Diving
Competitive and Recreational Activities 277
Photo courtesy of Sports ‘n Spokes; Paralyzed Veterans of America
Instructors (PADI), and the YMCA. Also available is
the national DSO, Handicapped Scuba Association
International (HSAI), founded in 1981 by Jim Gatacre.
Unlike the more traditional scuba certification pro-
grams, the HSAI uses a multilevel credential that
classifies divers according to physical performance,
regardless of type of disability. Level A consists of
diving students who can care for themselves and
others, level B includes students who need partial
support, and level C includes students who need full
support. For more information, see also appendix E
and refer to Jankowski (1995), Paciorek and Jones
(2001), and Robinson and Fox (1987). Founded in
1993, another organization involved with these
activities is the International Association for Handi-
capped Divers (IAHD). Located in the Netherlands,
the IAHD is similar to the HSAI in that it has three
levels of divers and conducts programs for instruc-
tor training. The IAHD publishes a newsletter for its
members and conducts seminars, symposiums, and
dive conventions.
Safety
Everyone agrees that certified divers should possess
requisite knowledge and skills for a safe and success-
ful experience, but controversy surrounds the issue
of medical clearance and certification. Scuba diving
has been generally accepted for most individuals
with orthopedic, visual, and hearing disabilities,
278 Adapted Aquatics Programming
but secondary disabilities, such as limited breathing
capacity, osteoporosis, poor circulation, tempera-
ture regulation disorders, psychological conditions,
seizure disorders, insulin-dependent diabetes, and
asthma, present a real concern for physicians and
dive instructors (Lin, 1987; Paciorek & Jones, 2001;
Petrofsky, 1994a, 1994b, 1995). Presently, the only
sound advice is for the prospective diver with a dis-
ability to consult a physician experienced in hyper-
baric medicine and to be conservative when making
all decisions related to scuba diving.
Equipment and Technique
Snorkeling and scuba diving require a significant
financial investment and individuals with disabilities
often need specialized equipment that is not available
by renting, so they should approach the purchasing
of equipment cautiously. As the program provider,
you may consider working collaboratively with the
diver, the scuba instructor, and the dive shop to
ensure equipment is appropriate. The dive instructor
can recommend the proper equipment, and you can
assist by knowing the strengths and weaknesses of
the diver. Some modifications to equipment might
include pressure gauges that have braille numbers
or that emit auditory signals, tethers that keep divers
together, hand paddles or swim mitts, diving boots,
low-volume masks, octopus regulators, jacket-type
buoyancy compensators, flexible vented fins, wet
suits, and diver propulsion vehicles for those who
cannot propel themselves (Paciorek & Jones, 2001).
Boating
Boating is a generic term used to represent a variety
of water activities involving a small craft. Boating
activities are especially good for people with lower-
body impairment, since paddling, rowing, and sailing
emphasize upper-body strength, allowing them to
participate with peers and family members without
disabilities. USA Canoe/Kayak (USACK) is the NGB
for competitive kayaking and canoeing in the United
States and was established to recruit, train, and sup-
port athletes to compete in the Olympic Games in
flat-water sprinting and white-water slalom canoe
and kayak racing.
Sailing opportunities continue to expand through
new programs and adapted boats for individuals with
disabilities. The United States Sailing Association
(USSA) is the NGB for sailing under the Olympic
and Amateur Sports Act of 1998, and it continues
to promote sailing at all levels in the United States.
The USSA Sailors With Special Needs (SWSN) is the
national DSO.
Currently there are several classes of accessible
sailboats, and there are popular competitions in the
Paralympic Games and Special Olympics. Competi-
tive sailing continues to grow, and due to its popu-
larity it became a medal event at the 2000 Sydney
Paralympics.
USRowing is a nonprofit organization recognized
by the USOC as the governing body for rowing in the
United States. Adaptive rowing is defined as rowing,
sculling, or crewing for people with physical and
intellectual disabilities. Adaptive rowing encompasses
individuals with numerous disabilities. The objective of
adaptive rowing is to include as many competitors as
possible who would otherwise be unable to compete.
Thus, the minimum disability is set so that those who
would be at a significant disadvantage competing in
open competition are eligible to compete in adapted
competitions. The functional classification system has
three levels: A (arms only), TA (trunk and arms), and
the LTA (legs, trunk, and arms), with each defined by
ability within these groups. Due to organizations such
as the Philadelphia Rowing Program for the Disabled
and the Louisville Rowing Club Adaptive Rowing
Program, rowing has grown significantly during the
past several years. Due to growth in popularity and
addition of events at the Fédération Internationale
des Sociétiés d’Aviron (FISA) World Championships,
rowing has been added to the program for the 2008
Paralympic Games in Beijing.
Safety
Safety and risk management are concerns for every-
one in boating, but some individuals with disabilities
need to take extra precautions. If you plan to teach
boating as part of your adapted aquatics programs,
you should become a certified instructor through the
ACA or through the level I coaching program available
through USRowing. Webre and Zeller (1990) suggest
that safety planning for any boating class should
include determining accessibility to the boating site,
reviewing medical information and considerations
involved with any medical condition, assessing what
the participant can do on land, and determining what
medical information needs to be shared with others
in the group in relation to an emergency action plan.
Although boating offers a tremendous opportunity to
participate in outdoor activities and enhance fitness
and motor skill performance, it is still a water-based
adventure sport; thus, students should not venture
out into moving water until they have demonstrated
competence in still water.
The amount of responsibility a paddler or rower
should have depends on functional ability. Ensure
that you test balance, stability, and buoyancy of the

boat with paddlers or rowers and equipment before
undertaking a river or lake trip. Other elements
of safety include problems with embarkation and
disembarkation, instructor-to-student ratio, and—as
with all water sports—an emergency action plan. In
order to determine which boat, method, and paddle
are most appropriate, consider the participant’s bal-
ance, grip strength and endurance, coordination,
and upper-extremity ROM. Consider, too, how much
sight and hearing the person possesses, as well as
her ability to make decisions and her knowledge of
cause and effect.
Equipment and Technique
The instructional process parallels that for individu-
als without disabilities; however, choosing the con-
tent, techniques, and equipment may involve extra
thought, time, and money. Water orientation should
be the first step, and it should include instruction in
safety, personal rescue, and using a PFD. After the
water orientation, boat orientation may begin on
land, moving into a pool, then to still open water, and
finally to moving open water. Boat orientation should
include terminology that is understandable to the
participant, exploration of the boat by blind partici-
pants, entry and exit procedures, and propulsion and
steering techniques. It is at this time that participant
and instructor must work together to modify equip-
ment through trial and error, based on knowledge of
available commercial equipment.
You can modify entry and exit procedures several
ways. A modification may be as simple as your stand-
ing in the water and stabilizing the boat. Or you and
an aide or two may opt to use a transfer mat to move
the participant from the dock into the boat. If the
riverbed or lakebed is firm enough, consider push-
ing a water wheelchair into shallow water for water
entries, having assistants help lift and transfer.
To help a paddler with cognitive impairment, you
can enhance propulsion techniques by printing the
words right and left on the opposite paddle blades on
a double-blade paddle or on the inside of the boat.
Other equipment modifications you can make are to
paint the inside of the boat with nonslip paint, use
Competitive and Recreational Activities 279
suction-cup bath mats on the bottom or seats of the
boat, have various paddle lengths available, and have
the participant use rubber or leather palm gloves for
a better grip.
There are single boats (for solo paddlers) and
double kayaks (for two paddlers). Commercial equip-
ment for seating and gripping is available, such as
a custom-made seat, Ensolite on the seat to protect
people with skin problems, and wet suits to pre-
vent hypothermia. WinTech Racing (www.wintech
racing.com) is the official supplier of adaptive rowing
equipment to the FISA World Rowing Championships,
offering a complete line of adaptive rowing accesso-
ries. Items include adaptive rowing shells, fixed and
adjustable seating pontoons, and strapping.
Summary
Competitive and recreational opportunities in aquat-
ics for individuals with disabilities continue to gain
popularity. Recreational and competitive opportuni-
ties are part of the typical lifestyle of most U.S. citi-
zens, and participation in these events creates a level
playing field for all cultures in the United States. We
must afford individuals with disabilities opportunities
to participate in swimming, diving, skiing, rowing,
sailing, and every other available water sport or activ-
ity. Such access and participation provides indepen-
dence, a healthy competitive spirit, justification for
an active lifestyle, use of community facilities, release
from everyday tensions, and networking with people
of similar interests. Not everyone wants to participate
in the competitive aspects of aquatics, so recreational
opportunities must also be available. Individuals
with disabilities can benefit greatly from transitional
instructional aquatics, in which participation and
goals are instructor directed in competitive and rec-
reational activities that involve independence and
goal setting to prepare individuals with disabilities
for community living. Aquatics as a lifelong endeavor
is a worthwhile activity because it develops valuable
skills needed throughout life.
280 Adapted Aquatics Programming

Chapter 12
Review 1. Discuss the effect of OASA (PL 105-77) on sport competition for persons
with disabilities.
2. What is the definition of physical education in IDEA (PL 101-476)?
3. What is the goal of USA Swimming for swimmers with disabilities?
4. List the seven DSOs that represent adapted aquatic competition in the
United States.
5. List three modifications to competitive swimming sanctioned by USA Swim-
ming.
6. Discuss the challenges presented by issues regarding segregated (based
on disability) versus integrated (cross-disability) aquatic competition.
7. How does including athletes with disabilities in regular aquatic teams ben-
efit the individuals without disabilities?
8. Define the term classification as it applies to adapted swim events.
9. Describe the cross-disability integrated functional classification system for
swimming.
10. What role can a swim coach of athletes with disabilities play?
11. List ways that you can adapt three recreational aquatic activities for indi-
viduals with disabilities.

Adapted Aquatics
Position Paper of the
Aquatic Council:
AAALF and AAHPERD
Adapted aquatics constitutes aquatic instruction and
recreation for individuals with disabilities. Individuals
of all ages with various physical, sensory, or mental
disabilities want, need, and possess the legal right
to have opportunities in the same aquatic activi-
ties, in the same environments, in the same ways as
persons without disabilities have. Individuals with
disabilities participate in aquatic instruction and
recreation for the same reasons as persons without
disabilities—learning specific aquatic skills, taking
part in leisure recreational activities, developing and
maintaining appropriate levels of personal fitness
and wellness, responding to individual challenges,
having opportunities to socialize with families and
friends, taking part in competitive aquatic activities,
and having fun by enjoying life through the aquatic
medium. This position paper delineates the scope of
aquatics for individuals with disabilities within the
broader frame of aquatics organization, administra-
tion, and participation.
Appendix A
Adapted aquatics is a broadly encompassing con-
cept that includes the following beliefs:
• Aquatic activities of all types—instructional to
competitive swimming, water aerobics, fitness
and wellness activities, water games, crew,
diving, small craft activities, skin and scuba
diving, water park activities, sailing, motorized
water ventures, and surfing—provide opportu-
nities for individuals with disabilities to improve
qualities of their lives through active participa-
tion, particularly with families and friends.
• Individuals with disabilities have a right to
participate regardless of where they live—inner
city, suburbia, or rural communities.
• Aquatics for individuals with disabilities is a
life-span activity and should be approached
as such.
281
282 Appendix A
Aquatic instruction and recreation involving
individuals with disabilities should not be confused
with aquatic therapy or hydrotherapy, an extremely
important part of rehabilitation processes.
• The two are not synonymous—each has its own
distinct goals and specific objectives.
• This distinction does not negate therapeutic
contributions from educational and recreational
aquatics programs or educational and recre-
ational values of therapeutic programs.
• Focus must be kept on primary goals and objec-
tives, either instructional or therapeutic, when
involved in each of these programs.
Most aquatic instructional sequences and pro-
gressions are appropriate and applicable for use
with individuals with disabilities, regardless of type
or severity of disability. Creativity, innovation, and
resourcefulness are keys to successful uses of these
progressions and sequences. This might include, but
is not limited to
• being sure activities and approaches are age
appropriate;
• entering into a sequence at appropriate points
for the individual, rather than at predetermined
group objectives;
• introducing more basic steps in progressions
(starting at lower levels);
• breaking skills down into smaller and more
manageable steps;
• basing approaches on functional aquatic skills,
not upon medical diagnoses—recognizing how
an individual’s disability affects ability to learn
and perform aquatic skills and activities;
• personalizing and individualizing instruction,
addressing each individual’s ability to perform
applicable skills, with or without flotation or
assistive devices; and
• introducing accommodations to meet needs of
each individual student.
Safety is a critical component. Safety instruction
must be a part of all aquatic activities.
• Flotation devices should be used only under
direct supervision of an instructor, should not
be used as a substitute for lifeguard surveillance
or instruction in skills, and should be used only
until independence or the appropriate skills can
be developed.
• Swimming—competitive, instructional, or
recreational—should take place under supervi-
sion of a lifeguard whose sole responsibility is
surveillance of participants.
• All aquatic instruction should be provided by
an individual credentialed by a national aquatic
agency.
• All safety rules and participation safeguards
applicable in regular programs apply to adapted
aquatics.
• Water safety education and skills must be inte-
grated with all aquatic activities, regardless of
the type of aquatic activity or functional level
of the participation.
Individuals with temporary or permanent disabili-
ties should participate in regular aquatics activities
whenever possible and only be placed in special
programs when absolutely necessary. These spe-
cial programs should be reserved for students who
cannot, for whatever reasons (physical, mental, social,
emotional), safely, successfully, and with personal
satisfaction take part in regular aquatics programs.
Participants in special programs should work toward
the same basic goals as peers in regular programs.
Instructors should always focus on individualized
goals and personalized objectives. Emphasis in spe-
cial classes and activities should be on preparing an
individual for active participation in appropriate regu-
lar programs. Regardless of setting, the total aquatics
facility must be accessible—parking entrances, locker
rooms, showers, restrooms, and the pool itself.
There is a need for aquatics specialists with specific
training and competence relating to individuals with
disabilities. Their roles include
• teaching and leading individuals with disabili-
ties within special programs,
• serving as resources for aquatics generalists
by doing demonstration or team teaching and
conducting various aquatic activities in inte-
grated settings,
• assessing participants with disabilities,
• recommending and providing appropriate flota-
tion and assistive devices,
• suggesting instructional progression and
sequence accommodation for individual
aquatic needs,
• furnishing professional resources on adapted
aquatics and aquatic recreation for individuals
with disabilities, and

• conducting in-service training activities for
generalist instructors or program leaders, vol-
unteers, and others involved in any way in the
program.
Whether generalist or specialist, instructors must
be highly committed and dedicated to fulfilling their
moral and ethical responsibilities of meeting the
challenges of including participants with disabilities
in aquatic activities. They must also be strong advo-
cates for equality of opportunities through aquatics.
Instructors must possess empathy for individuals with
disabilities and be strong proponents for equality of
opportunity through aquatics. Teamwork through
communication, cooperation, and coordination with
other individuals and agencies is a must for success.
General ratio of students to teachers will be less where
individuals with disabilities are served. This ratio will
be reduced even further when students have more
severe conditions.
Appendix A 283
Adapted aquatics is a service delivery system
providing appropriate aquatic instruction and rec-
reation for participants with disabilities. This system
includes identifying, assessing, planning, instructing,
leading, and coaching individuals with disabilities
who desire to participate in aquatic instruction and
recreational activities. It also includes education,
consultation, and assistance to general aquatics
professionals, family members, health professionals,
and the community on providing equal opportunities
to participants with disabilities and on successfully
including them in aquatics programs to fulfill and
reaffirm the potential of aquatics to contribute to the
quality of their lives.
Reprinted by the kind permission of the American Association for Physical Activity
and Recreation.
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 Appendix B

Assessment Forms

285
 Aquatics Athlete Skills—Learn to Swim Assessment
Athlete Name _________________________________________ Start Date ________________________

Coach Name ____________________________________________________________________________

Instructions
Use this tool at the beginning of the training or competition season to establish a basis of the athlete’s
starting skill level.
Have the athlete perform the skill several times.
If the athlete performs the skill correctly 3 out of 5 times, check the box next to the skill to indicate that
the skill has been accomplished.
Intersperse assessment sessions into your program.
Swimmers may accomplish skills in any order. Athletes have completed the skills list when all possible
items have been achieved.

Water Adjustment
❑ Sits on pool edge
❑ Sits on pool edge and kicks

Water Entry—Assisted
❑ Sits on pool edge
❑ Walks down ramp
❑ Enters pool using stairs
❑ Climbs down ladder
❑ Slides into pool from edge

Water Entry—Independent
❑ Walks down ramp
❑ Enters pool using stairs
❑ Climbs down ladder
❑ Slides into pool from edge
❑ Jumps into shallow end

Breathing—Blows Air Out

❑ Blows air out
❑ Blows object across water
❑ Exhales while submerged

Breathing—Blows Bubbles
❑ Blows into water
❑ Blows water away
❑ Makes noises in the water
❑ Hums under water through nose

Breathing—Controlled
❑ Demonstrates continuous breathing and exhalation pattern
❑ Exhales through nose and mouth in a relaxed and rhythmical manner

286
Static Positions
❑ Stands in water with assistance
❑ Stands in water independently
❑ Stands in water against turbulence with assistance
❑ Stands in water against turbulence independently
❑ Lies on back in still position with assistance
❑ Lies on back in still position against turbulence with assistance
❑ Stands or sits in chair position with assistance
❑ Stands in chair position independently
❑ Stands or sits in chair position against turbulence with assistance
❑ Stands in chair position against turbulence independently
Water Confidence
❑ Puts face in the water
❑ Shows enough confidence not to grip coach
Walking in Water—Head Control
❑ Walks across pool in shallow water (waist deep) with assistance
❑ Walks across pool holding onto the side with one hand
❑ Walks across pool independently
❑ Walks across pool independently in shallow water
❑ Walks across pool with assistance in chest-deep water
❑ Walks across pool independently in chest-deep water
❑ Slides sideways or changes directions with assistance
❑ Slides sideways or changes directions independently
❑ Walks forward and backward with assistance
❑ Walks forward and backward independently
Jumping
❑ Jumps in shallow water with assistance
❑ Jumps in shallow water independently
Water Exit—Assisted
❑ Walks up ramp
❑ Climbs up ladder
❑ Maintains a safe position at side of pool
❑ Climbs out over side of pool
Water Exit—Independent
❑ Walks up ramp
❑ Climbs up ladder
❑ Maintains a safe position at side of pool
❑ Climbs out over side of pool
Forward Recovery
❑ Moves forward and backward while supported with feet off bottom
❑ Moves forward and backward while using two kickboards

(continued)
287
 Aquatics Athlete Skills—Learn to Swim Assessment (continued)

Submerging in Water
❑ Submerges in shallow water with assistance
❑ Submerges in shallow water independently
❑ Submerges in chest-deep water with assistance
❑ Submerges in chest-deep water independently

Opening Eyes Underwater

❑ Opens eyes underwater with goggles
❑ Opens eyes underwater without goggles

Sitting on the Bottom

❑ Touches pool bottom in shallow water
❑ Touches pool bottom in chest-deep water
❑ Sits on pool bottom in shallow water
❑ Sits on pool bottom in chest-deep water

Prone Float
❑ Attempts to float on stomach
❑ Floats on stomach with assistance (buoyancy belt)
❑ Performs prone float for 5 seconds independently
❑ Recovers from front float with assistance
❑ Recovers from front float using two kickboards with assistance
❑ Recovers from front float using two kickboards independently
❑ Recovers from front float independently
❑ Performs prone float and recovers to standing position
❑ Performs prone float with a flutter kick

Back Float
❑ Attempts to float on back
❑ Floats on back with assistance (buoyancy belt)
❑ Performs a back float for 5 seconds independently
❑ Recovers from back float with assistance
❑ Recovers from back float using two kickboards with assistance
❑ Recovers from back float using two kickboards independently
❑ Recovers from back float to stand independently
❑ Performs a back float and recovers to a standing position
❑ Performs a back float with a flutter kick

Rolling Recovery
❑ Recovers from front float to back float with assistance
❑ Recovers from front float to back float using flotation device with assistance

288
 ❑ Recovers from front float to back float using flotation device independently
❑ Recovers from front float to back float independently
❑ Moves from back float to front and returns with assistance
❑ Moves from back float to front and returns independently

Turbulent Gliding
❑ Floats on back while being propelled along

Push and Glide—Streamlined Position

❑ Pushes and glides on front with assistance
❑ Pushes and glides on front using flotation device, two kickboards, or noodle
❑ Pushes and glides on front using one kickboard
❑ Pushes and glides on front independently
❑ Pushes and glides on back with assistance
❑ Pushes and glides on back using two kickboards
❑ Pushes and glides on back using one kickboard
❑ Pushes and glides on back independently

Sculling
❑ Sculls using small arm movements
❑ Sculls using full arm movements

Kicking
❑ Kicks while holding onto poolside or gutter
❑ Kicks legs with coach’s assistance
❑ Moves forward using kickboard and flutter kick on back with assistance
❑ Kicks on front with assistance
❑ Kicks on front in glide position with assistance
❑ Kicks on front in glide position independently
❑ Moves forward using flutter kick independently
❑ Moves forward using back flutter kick independently

Mushroom Float
❑ Supported, rolls forward, blows bubbles, and rolls back
❑ Mushroom floats
❑ From back float, mushroom floats and recovers

Water Safety
❑ Identifies swimming boundaries
❑ Understands and identifies pool safety rules
❑ Floats in neck-deep water
❑ Demonstrates a vertical float in deep water for 2 minutes
❑ Demonstrates sculling arm action, five strokes in neck-deep water

Reprinted with permission from Special Olympics, Inc., from the Special Olympics Aquatics Coaching Guide. Accessed from www.specialolympics.org/special+olympics+
public+website/english/coach/coaching_guides/aquatics/default.htm.

289
 Freestyle Skill Progression

Your athlete can Never Sometimes Often

Make an attempt to swim on front ❑ ❑ ❑

Perform freestyle using flutter kick for 15 m ❑ ❑ ❑

Perform freestyle with rhythmic breathing for one pool length ❑ ❑ ❑

Make an attempt to start from in the pool ❑ ❑ ❑

Perform proper start from standing on the pool edge ❑ ❑ ❑

Perform proper start using a starting block ❑ ❑ ❑

Make an attempt to turn around without stopping ❑ ❑ ❑

Perform an open turn after swimming freestyle, without stopping ❑ ❑ ❑

Perform a flip turn in waist-deep water ❑ ❑ ❑

Perform flip turns after swimming 1 to 2 pool lengths ❑ ❑ ❑

Totals

Reprinted with permission from Special Olympics, Inc., from the Special Olympics Aquatics Coaching Guide. Accessed from www.specialolympics.org/special+olympics+
public+website/english/coach/coaching_guides/aquatics/default.htm.

290
 Backstroke Skill Progression

Your athlete can Never Sometimes Often

Swim on back ❑ ❑ ❑

Perform backstroke correctly for one pool length ❑ ❑ ❑

Start on back ❑ ❑ ❑

Perform backstroke start while facing the starting ❑ ❑ ❑

end with both hands on a starting block

Perform the correct backstroke start and swim one pool length ❑ ❑ ❑

Turn on back ❑ ❑ ❑

Perform backstroke turn with assistance ❑ ❑ ❑

Perform backstroke turn in chest-deep water without assistance ❑ ❑ ❑

Totals

Reprinted with permission from Special Olympics, Inc., from the Special Olympics Aquatics Coaching Guide. Accessed from www.specialolympics.org/special+olympics+
public+website/english/coach/coaching_guides/aquatics/default.htm.

291
 Breaststroke Skill Progression

Your athlete can Never Sometimes Often

Swim breaststroke on front ❑ ❑ ❑

Perform breaststroke with rhythmic breathing for one pool length ❑ ❑ ❑

Perform two breaststroke turns in a row after swimming ❑ ❑ ❑

1 to 2 pool lengths

Totals

Reprinted with permission from Special Olympics, Inc., from the Special Olympics Aquatics Coaching Guide. Accessed from www.specialolympics.org/special+olympics+
public+website/english/coach/coaching_guides/aquatics/default.htm.

292
 Butterfly Skill Progression

Your athlete can Never Sometimes Often

Swim butterfly on front ❑ ❑ ❑

Perform butterfly with dolphin kick for 15 m ❑ ❑ ❑

Perform butterfly with rhythmic breathing for one pool length ❑ ❑ ❑

Perform butterfly turn after swimming butterfly, without stopping ❑ ❑ ❑

Perform two butterfly turns in a row after swimming two ❑ ❑ ❑

pool lengths

Totals

Reprinted with permission from Special Olympics, Inc., from the Special Olympics Aquatics Coaching Guide. Accessed from www.specialolympics.org/special+olympics+
public+website/english/coach/coaching_guides/aquatics/default.htm.

293
294
Name

Reprinted courtesy of James DePaepe, 1980.

Some front buoyancy while assisted
Some back buoyancy while assisted
Retrieves objects in waist-deep water
Bracket for prone float
Prone float, chest-deep with assistance
Chest-deep bend and tuck knees
Jellyfish float with assistance
Jellyfish float without assistance
Jellyfish extending arms and legs
Assistance to standing position
Standing recovery unassisted
Back float with instructor support
DePaepe Positioning and Buoyancy Checklist

Assistance to standing position

Standing recovery unassisted
Kicking on front using a support
Kicking on back using a support

Comments
 Name
Prone glide push-off from side

Reprinted courtesy of James DePaepe, 1980.

Prone glide with recovery
Prone glide for 10 ft
Prone glide with kick, using kickboard
Prone glide with kick
Prone glide with flutter kick 20 ft
Prone glide with flutter kick and breathing
Back glide with push-off from side
Back glide with recovery assistance
Back glide with relaxed flutter kick
Back glide with sculling action
Doggy paddle, arms alone
Doggy paddle with arms and legs
Standing crawl stroke, shallow end
Crawl stroke, fingers dragging in water
Crawl stroke and roll
DePaepe Propulsion in the Water Checklist

Crawl stroke and kick

Rhythmic breathing using only arms
Rhythmic breathing using legs only
Rhythmic breathing using combinatin
Beginning elementary back, arms only
Back glide with sculling and finning
Treading water
Survival floating
Drown proofing

295
 The Water Orientation Checklists

Directions for the Water Orientation Checklist—Basic (WOC-B)

The following 13 items are assessed using a five-choice rating scale. The observer records only success-
ful performances by circling an “s” on the appropriate level of the rating scale. Rating scale choices use
the following abbreviations and operational definitions:
• Spontaneous (SP): the subject performs one of the 13 tasks prior to an instructor’s verbal direc-
tions.
• Verbal (VB): the subject performs the specified task after the instructor’s verbal directions.
• Verbal with demonstration (DMO): the subject performs the specified task after the instructor’s
verbal directions and visual cues.
• Physical guidance (PG): the instructor manipulates the subject’s body through the specified task;
verbal directions and visual cues accompany manipulation.
• Objection (OBJ): the subject is unwilling to attempt the task either passively or actively.

Directions for the Water Orientation Checklist—Advanced (WOC-Adv)

The following 13 items are assessed by recording both successful and unsuccessful performances on
each level of the five-choice rating scale. For each item it is possible to record several unsuccessful per-
formances prior to recording a successful performance. The observer records performance by circling
one or more abbreviations. The following abbreviations and operational definitions are used:
• Successful (s): the subject performs the task as defined.
• Unsuccessful (u): the subject demonstrates an overt motor response in which he or she attempts
but fails to perform the specified task.
• Passive objection (p): the subject fails to attend to the task, says “no,” or shows no overt motor
response.
• Active objection (a): the subject pulls away, runs away, throws a tantrum, abuses self, yells, or
screams.

Item
WOC-B WOC-Adv

1. The instructor holds the subject by the hand as they walk to a predetermined SP s s u
location 8 ft from the pool. Instructor then releases subject’s hand and subject VB s s u
proceeds toward the pool: DMO s s u
PG s s u
OBJ obj p a

2. The subject touches the water with either hand or foot: SP s s u

VB s s u
DMO s s u
PG s s u
OBJ obj p a

3. The subject enters the pool by placing both feet in shallow water: SP s s u
VB s s u
DMO s s u
PG s s u
OBJ obj p a

296
 4. The subject remains in pool throughout the observation:
a. spontaneously
b. exits, returns after verbal direction
c. exits, returns after verbal direction with demonstration
d. exits, returns with physical guidance
e. exits, and objects to returning to the pool

WOC-B WOC-Adv

5. The subject attains a sitting, squatting, or horizontal position (wet up to SP s s u

waist) in the water: VB s s u
DMO s s u
PG s s u
OBJ obj p a

6. The subject blows bubbles (mouth contacts water and exhalation produces SP s s u
bubbles): VB s s u
DMO s s u
PG s s u
OBJ obj p a

7. The subject submerges entire face (forehead, eyes, nose, mouth, chin) in SP s s u
water: VB s s u
DMO s s u
PG s s u
OBJ obj p a

8. The subject performs a back float (ears in water, arms and legs extended, SP s s u
mouth and nose out of water, feet not touching the bottom): VB s s u
DMO s s u
PG s s u
OBJ obj p a

9. The subject performs a back float recovery (attaining a standing position SP s s u

without face submersion): VB s s u
DMO s s u
PG s s u
OBJ obj p a

10. The subject performs a prone float (face submersion, arms and legs SP s s u
extended, feet not touching the bottom): VB s s u
DMO s s u
PG s s u
OBJ obj p a

11. The subject performs a prone float recovery (attaining a standing position SP s s u
without turning over): VB s s u
DMO s s u
PG s s u
OBJ obj p a

12. The subject performs a turnover from back to prone float (without touching SP s s u
bottom): VB s s u
DMO s s u
PG s s u
OBJ obj p a

13. The subject swims 5 ft (any propulsive movement without touching bottom): SP s s u
VB s s u
DMO s s u
PG s s u
OBJ obj p a

Note unusual behavior: ______________________________________________

Reprinted, by permission, from K.J. Killian, S. Arena-Ronde and L. Bruno, 1987, “Refinement of two instruments that assess water orientation in atypical swimmers,” Adapted
Physical Activity Quarterly 4(1): 25-37.

297
 Aquatic Orientation Checklist

Observer checks one behavior for each numbered item:

1. Instructor and subject begin to walk toward pool:
a. Subject spontaneously leads by pulling instructor’s arm. _____
b. Subject walks voluntarily. _____
c. Instructor manipulates subject toward pool. _____
d. Subject objects to task. _____
Note unusual behavior: _________________________________________________________________
2. At edge of pool, subject touches water with hand or foot:
a. Spontaneously. _____
b. Voluntarily with demonstration. _____
c. Subject requires manipulation to touch water. _____
d. Subject objects to task. _____
Note unusual behavior: _________________________________________________________________
3. Subject enters the pool (both feet in shallow water):
a. Spontaneously. _____
b. Voluntarily with demonstration. _____
c. Instructor manipulates subject into pool. _____
d. Subject objects to task. _____
Note unusual behavior: _________________________________________________________________
4. Subject attains a sitting, squatting, or horizontal position in the water:
a. Spontaneously. _____
b. Voluntarily. _____
c. After manipulation by instructor. _____
d. Subject objects to task. _____
Note unusual behavior: _________________________________________________________________
5. Subject blows bubbles (mouth contacts water and exhalation produces bubbles):
a. Voluntarily. _____
b. Voluntarily after demonstration. _____
c. After manipulation. _____
d. Subject objects to task. _____
Note unusual behavior: _________________________________________________________________
6. Subject submerges entire face (forehead, eyes, nose, mouth, chin) in water:
a. Spontaneously. _____
b. Voluntarily after demonstration. _____
c. After manipulation. _____
d. Subject objects to task. _____
Note unusual behavior: _________________________________________________________________

Reprinted, by permission, from K.J. Killian, R.A. Joyce-Petrovich, L. Menna and S.A. Arena, 1984, “Measuring water orientation and beginner swim skills of autistic individu-
als,” Adapted Physical Activity Quarterly 1(4):287-295.

298
Beginning Competency Levels of Swimming
Sherrill Model

Note: Due to rights limitations, this item has been removed.

The material can be found in its original source.
From C. Sherrill, 2004, Adapted physical activity, recreation
& sport: Crossdisciplinary and lifespan, 6th ed.
(New York, NY: McGraw-Hill), 473-475

299
 Conatser Adapted Aquatics Screening Test Sheet

Name of student _________________________________________________________________________

Key: (P) Pass = 1, (0) Fail = 0, (–) Emerging, inconsistent = 0 points

A. Psychological and physical adjustment skills P, 0, – 1 point each

1. Enters pool area displaying adequate behavior _____ _____
2. Puts feet in water, pool side _____ _____
3. Puts hands in water, pool side
4. Rubs water or accepts water on shoulders, pool side _____ _____
5. Sits in chest-deep water, 1 min _____ _____
6. Puts chin in water while sitting _____ _____
7. Puts ears in water while sitting _____ _____
8. Puts nose in water while sitting _____ _____
9. Puts forehead in water while sitting _____ _____
10. Accepts needed level of assistance into deeper water _____ _____
11. Accepts shoulder-deep water, 30 s _____ _____
12. Approves being supported by evaluator (no time requirement [NTR]) _____ _____
13. Approves of swaying movement by evaluator (NTR) _____ _____
14. Approves of vertical position changes by evaluator (NTR) _____ _____
15. Approves of supine position by evaluator (NTR) _____ _____
16. Demonstrates relaxation in supine position by evaluator, 15 s _____ _____

B. Entering and exiting the pool P, 0, – 1 point each

17. Enters and exits via ramp, stairs, ladder, or lift, assisted or
unassisted, safely _____ _____
18. Sits pool side and falls forward into evaluator’s arms,
3 out of 4 times _____ _____

C. Range of motion (ROM) in water P, 0, – 1 point each

19. Accepts passive trunk rotation _____ _____
20. Accepts passive ROM of upper extremities _____ _____
21. Accepts passive ROM of lower extremities _____ _____

D. Breath control and respiratory skills P, 0, – 1 point each

22. Blows bubbles in instructor’s hands, 3 out of 4 times _____ _____
23. Blows bubbles, face submerged in the pool, 3 out of 4 times _____ _____
24. Closes lips while face is submerged, 3 out of 4 times _____ _____
25. Puts head under water, 10 s _____ _____
26. Sits poolside, rolls forward into water, remaining prone safely,
8 s, 3 times* _____ _____
27. Sits poolside, rolls forward into water, floats to surface prone
then to supine, unassisted, 3 times _____ _____

300
E. Balance and flotation P, 0, – 1 point each
28. Maintains standing or kneeling position in
shoulder-deep water, 2 min* _____ _____
29. Walks or moves in shoulder-deep water, 3 yards,
3 out of 4 times* _____ _____
30. Maintains supine float unassisted, 10 s, 3 times* _____ _____
31. Maintains prone float unassisted, 7 s, 3 times* _____ _____
32. Maintains supine position with PFD, 2 min* _____ _____
33. Rolls from prone to supine floating unassisted,
3 out of 4 times* _____ _____

F. Active movement in water P, 0, – 1 point each

34. Kicks on surface of water _____ _____
35. Moves arms underwater _____ _____
36. Moves legs underwater _____ _____
37. Sculls with hands _____ _____
38. Demonstrates power arm strokes _____ _____
39. Demonstrates rotary leg kick _____ _____
40. Holds onto pool side, 1 min _____ _____
41. Pushes off from pool side into evaluator’s arms,
3 out of 4 times _____ _____
42. Moves through water with PFD, 3 yards, 3 out of 4 times* _____ _____
43. Moves through water independently, 3 yards, 3 out of 4 times _____ _____
44. Moves independently from evaluator to a safe place,
3 yards, 3 out of 4 times* _____ _____

Total _____

Percentile _____

Total points for selected sections: A. _____ B. _____ C. _____ D. _____ E. _____ F. _____

Percentiles for selected sections: A. _____ B. _____ C. _____ D. _____ E. _____ F. _____

* These skills are especially important to attain.

Reprinted courtesy of Phillip Conatser, University of Texas at Brownsville.

301
 Carter, Dolan, and LeConey Aquatic Assessment

Directions
Prior to instruction, observe and interview the participant and significant others to identify function-
ing abilities and factors having an effect on performance in the aquatic environment. Report presence
(with date accomplished) or absence (left blank) of behaviors and, in some instances, record time and
number of behaviors.

Sensory behaviors
Auditory
____ Deaf
____ Hard-of-hearing
____ Hearing loss in ____ right ear in ____ left ear
____ Wears hearing aid
____ Listens to speech
____ Covers ears when hears loud noises
____ Self-stimulates when hears loud noises
____ Creates noise or echo in response to noises

Visual
____ Blind
____ Visually impaired
____ Discriminates light and dark
____ Discriminates shadows
____ Looks at light reflection on water
____ Wears glasses in water
____ Will wear ____ won’t wear goggles
____ Will wear ____ won’t wear mask
____ Opens and closes eyelids
____ Looks at speaker
____ Looks at objects in visual field
____ Looks down ____ does not look down into the water
____ Watches objects move ____ horizontally ____ vertically
____ Steps over ____ does not step over lines or objects
____ Reaches for support when looking down or stepping over
____ Covers eyes to prevent water entry

Tactile
____ Touches safety equipment ____ touches flotation equipment
____ Touches others ____ resists touch of others
____ Touches others only if controls the touch of others
____ Holds objects
____ Wears equipment

Speech and breathing

____ Creates audible speech ____ number of words
____ Cries ____ laughs
____ Makes noise ____ number of seconds

302
____ Uses manual communication device ____ computer to respond
____ Drinks ____ licks water
____ Allows water to move in and out of mouth for stimulation
____ Breathes through mouth
____ Breathes through nose
____ Breathes through mouth and nose
____ Breathes through mouth with nose pinched
____ Closes mouth with nose pinched
____ Opens mouth with nose pinched
____ With nose pinched, holds breath, blows out for ____ seconds
____ With nose pinched, breathes in, blows out for ____ seconds
____ With nose pinched, blows out for ____ seconds, breathes in
____ Foam appears around mouth from swallowing air
____ Enlarged tongue
____ Able ____ unable to open and close mouth
____ NG tube ____ tracheostomy ____ ventilator-dependent
____ False teeth ____ braces ____ plate ____ cleft palate

Self-care
____ Identifies personal belongings
____ Dresses ____ undresses
____ Toilets without ____ with assistance
____ Wears diaper
____ Wears collection device
____ Uses catheter
____ Hair appears washed ____ unwashed
____ Places hands over face when hair is washed

Emotions displayed
____ Apprehension ____ Fear ____ Anger ____ Aggression
____ Happiness ____ Confidence ____ Trust ____ Success

Social interactions
____ Holds hands of others
____ Talks with others
____ Stays in ____ withdraws from group
____ Seeks to control group dynamics ____ Withdraws when not in controlling position

Cognitive
____ Identifies directions: ____ up ____ down ____ under ____ over ____ right ____ left
____ Identifies body parts
____ Identifies safety and flotation devices
____ Recognizes and responds to name
____ Attends to task ____ seconds
____ Follows 1-2 step ____ 3-5 step directions
____ Responds to verbal ____ visual ____ written directions
____ Counts to: ____ 3 ____ 5 ____ 10
____ Comprehends a count to: ____ 3 ____ 5 ____ 10

(continued)
303
 Carter, Dolan, and LeConey Aquatic Assessment (continued)

Motor
Stature
____ Trunk long ____ short
Muscle mass location
____ Upper torso ____ Lower torso ____ Upper limbs (__ R __ L) ____ Lower limbs (__ R __ L)
Adipose tissue location
____ Upper torso ____ Lower torso ____ Upper limbs (__ R __ L) ____ Lower limbs (__ R __ L)
Head control
____ Rotates head ____ R ____ L
____ Lifts head from prone position ____ from supine position
Balance
____ Sits without ____ with assistance
____ Stands without ____ with assistance
____ Stands on ____ R foot ____ L foot
____ Walks without ____ with assistance
____ Walks forward ____ backward
____ Runs forward ____ backward ____ zigzagging
____ Hops foward on ____ R foot ____ L foot
____ Jumps fowards ____ backward with 2 feet off ground
Ambulation
____ Independently
Ambulates with:
____ Prosthesis (__ R __ L __ both) ____ Orthopedic device (__ R __ L __ both) ____ Walker
____ Crutches ____ Wheelchair
Walks with:
____ Even cadence ____ On toes ____ Heel-to-toe ____ Feet inverted ____ Feet everted
____ Parallel arm swing ____ Opposition arm swing
Hands, arms, shoulders
____ Arms extended ____ flexed
____ Grasps ____ Releases ____ Claps
____ Transfers objects from one hand to the other
____ Crosses midline with R hand and arm ____ L hand and arm
____ Clamps down on top of instructor’s or other’s hand(s), arm(s)
____ Shoulders broad ____ narrow
Feet, legs, hips
____ Legs extended ____ flexed ____ in scissors position
____ Legs long ____ short
____ Lifts R foot ____ L foot off ground
____ Squats at knees ____ does not squat at knees
____ Bends at waist ____ does not bend at waist
Muscle tone
____ Flaccid ____ Spastic ____ Contractures ____ Uninhibited reflexes

Reprinted, by permission, from Carter, Dolan, and LeConey, 1994. Designing instructional swim programs for individuals with disabilities (Reston, VA: AAHPERD), 15-17.

304
 Appendix C

Games and Activities

for Various Age Groups

305
 6-36 Months Old

Going to the Market

Materials Three dozen pieces of plastic fruit (one dozen of three different kinds), three hoops,
laminated pictures of the fruits you have.
Goals 1. To increase familiarity with water by taking their minds off where they are
2. To improve ability to get child’s hands off caregiver and reach out for something
3. To improve sense of group
4. To increase comfort on stomach
5. To develop ability to sort by color, shape, and size
How to Play Have parent-child pairs scatter around shallow, buoyed-off area. Anchor or hold three
hoops by a wall and place a laminated picture above each tube of one of the plastic
fruits that are available in the game. Spread fruit around water and ask caregivers to
hold participants at their side facing forward and have children make progress toward
fruit with caregiver gliding them along with face above the water, on their stomach,
encouraging them to kick or use arm stroke. Once child has grabbed a fruit, have
caregiver name it. Have child drop fruit into hoop with the corresponding picture
above it and repeat the process with two other kinds of fruit.
Tip Hold child’s bottom slightly lower (three to four inches) than shoulders so child’s head
stays more naturally above water.
Adaptations For students who cannot grasp an object that large, put fruit in a knee-high stocking
and tie top so child can grasp stocking top. For students who are visually impaired,
use opportunity to describe fruits, have child reach into hoop first to feel if it matches,
or instead of using fruit, use toys with various sounds.

Water the Garden

Materials 1 small plastic watering can per pair, 12 various fake flowers stuck into the pool gutter
or lane lines
Goal To improve water orientation
How to Play Start with child/adult pairs in a circle, having them bob up and down to shoulders
singing a song about rain, flowers, or the like. Use a watering can to wet children’s
feet, caregiver’s shoulders, and so on. Now give each pair a watering can and have
everyone water a flower. At each flower, have caregiver gradually pour water on
child’s various body parts.
Tip Don’t have caregiver pour water on face until child feels very comfortable about
having water on neck, chin, and back of head.
Adaptation For those who cannot perform without independence, caregiver or instructor should
provide physical assistance for using the watering can.

Magic Carpet Ride

Materials One kickboard per child
Goals 1. To improve head control
2. To develop confidence in prone position
3. To introduce kicking
4. To explore pool
How to Play Have each caregiver position child’s arms and upper body on kickboard, holding the
child onto the board. Encourage caregivers to use various speeds of gliding, push off
the wall by placing child’s feet on wall, and even introduce the flutter kick. Have care-

306
 givers go to various places in the pool where there is a laminated picture of children’s
favorite characters (e.g., Mickey Mouse, Big Bird, or Sponge Bob). After they visit,
have them continue the magic carpet ride, kicking and gliding to another location.
Tip Show each caregiver how to hold child and kickboard, depending on child’s body
control and comfort in the water.
Adaptations Place action figures near pictures for those with poor eyesight to feel. Those with more
severe physical disabilities may need to wear a tube or life jacket.

Rubber Duckie
Materials Tape player with Sesame Street song “Rubber Duckie” playing (record it about five
times in a row), 1 floating duckie with a short (4 in.) ribbon (not string) around its neck
per child
Goal To increase comfort lying on back
How to Play Place ducks in gutter. Have caregiver hold child so that they are facing the gutter with
child’s back to caregiver’s chest, head near shoulder. Have pair walk backward to
other side of pool once the child has grabbed the duck’s ribbon, happily giving the
duck a ride while singing “Rubber Duckie.” Have caregiver gradually begin to squat
down in water until after a few laps of duck-walking, the child is reclining on adult’s
shoulder. Child can also place duck on the chest or adult can hold it above child to
encourage the child to lie on his back.
Tip Watch out for ribbons near children’s necks and mouths; remove ribbons from ducks’
necks for free play.
Adaptation Use ducks that squeak to motivate all students and to help visually impaired students.

3-5 Years Old

The Team Is in the Huddle

Materials None
Goal To imitate water orientation skills
How to Play Form a circle in water where children can stand, or have aides hold the children
facing the middle of the circle. Pick one child to be the captain for each time the
game starts, until all the children have had a turn. The game starts by each person put-
ting one hand in the middle of the circle so there is a pile of hands (like a team does
before they play). The group chants the cheer “The team is in the huddle; the captain’s
at the head; they all got together; and this is what he [or she] said. . . .” The captain
then says a skill or demonstrates a skill (or both) that everyone has to try to do, to the
best of their abilities. After about 10 seconds of trying, have the group come back in
together, each person putting one hand in the middle again, and you pick another
captain. Begin the chant again and continue the game until all have had a chance to
be the captain.
Tip Encourage children to do whatever they can to approximate the skill that the captain
is demonstrating.
Adaptations Give children who have problems processing information quickly a warning when
they are going to be captain, so they have time to think of a skill. Help children with
severe cognitive problems demonstrate a skill (like splashing their hand or foot, or
jumping up and down). Children with poor range of motion or no hands can put their
elbow or foot in the middle of the circle of hands, or put their hand on their assistant’s
arm and the assistant puts own hand in the circle.

(continued)

307
 London Bridge
Materials Foam noodles
Goals To practice creative and individual swimming
How to Play Hold one end of a foam noodle and put the other end on the deck. Encourage swim-
mers to swim under the noodle in any manner they wish or in a way you call out. Sing
“London Bridge” as all are going under the noodle and then swimming around your
back to go under again.
Tips Putting two noodles together with a foam attachment is easiest. Keep a lookout for
those swimming around your back. Bridge can go up and down closer to the water as
needed.
Adaptations Allow physical assistance or flotation device for those who need it. Eliminate singing
for those who can’t hear. Allow touching of your back (for orientation) and the noodle
for those who can’t see.

6-8 Years Old

Birthday Party
Materials Corks, several Styrofoam rings, reaching pole, one kickboard per child
Goals 1. To improve breath control
2. To improve flutter kick
3. To improve underwater swimming skills
How to Play Part One: “Make a Cake.” Split group in half on either side of the pool in the water,
each participant holding a kickboard. On signal, have participants kick toward the
middle and then stop and pile kickboards on each other until the group makes a
“layer cake.”
Part Two: “Blow Out the Candles.” Replace layer cake of kickboards with one Styro-
foam ring for every three children. Balance the corks on the ring. After students sing
“Happy Birthday,” have them blow the corks off the ring, like candles, and then place
their mouths in the water to try to blow corks out of the ring.
Part Three: “Limbo.” Use reaching pole to do limbo dance. Place pole as far into or
out of the water as participant ability allows. Ask students to do whatever movement
they want, a different one for each pass under the pole. Challenge with questions such
as “Who can let their feet go first?”
Tip Use limbo music for extra motivation and fun.
Adaptation Allow individuals with visual impairment to feel bar.

Escape Hatch
Materials One hoop for every two children
Goals 1. To improve underwater swimming
2. To increase spatial awareness
3. To increase independent water movement
How to Play Start with half the group in a circle holding a hoop between each person, at all differ-
ent levels—some hoops touching bottom, some mid-depth of water, and others half
out of the water. In the middle of the circle, have the other half of the group perform
some swim skills commensurate with each individual’s ability (such as bobbing) in the
middle of the circle. When you say “Escape hatch!” have all in the middle head for a
hoop of their choice and swim through it. Then have them swim around the outside
of the circle until you give the signal again. Repeat the process from the outside of
the circle to get back inside the circle. Periodically, switch two hoop holders at a time

308
 with swimmers, for maximum participation. Encourage participants to swim through
as many different hoops as they will challenge themselves with.
Tip Hoop holders can move in a circle during the game.
Adaptations Individuals who cannot swim can walk, jog, or be pulled through the hoop while in a
PFD. Have those who are nonverbal and cannot swim point to the hoop they want to
try and then assist them.

Musical Hoops
Materials One hoop per person, music that can be stopped and started
Goals 1. To develop cooperation
2. To develop confidence submerging
3. To develop independence and confidence moving in pool without holding the edge
How to Play Spreads hoops around shallow (or for advanced class, deep) end. Have participants
walk or swim around until music stops. Then have them find a hoop and swim into it
from underwater. To make this an even more cooperative game, remove several hoops
and have participants share hoops when the music stops.
Adaptations For students with visual impairment, allow them to touch hoops or direct them toward
an empty hoop. For students who are hard of hearing or deaf, wave flag or cloth or
clap while music is on. For students with mobility difficulties, offer support (aide or
PFD) to swim or walk.

9-11 Years Old

Backstroke Flag Touch

Materials Backstroke flags
Goals 1. To encourage shoulder extension while on back
2. To improve arm recovery in back crawl
How to Play String several rows of backstroke flags to within two feet of water surface. Have every-
one swim on back, trying to touch the backstroke flags with each recovery of arms.
Tips Group faster students together so they don’t crash backward into slower swimmers.
Have faster swimmers complete more widths.
Adaptations Suspend bells for visually impaired swimmers. Suspend one row of flags lower for
those with short arms or limited range of motion. Offer flotation devices or physical
support or both to those who need it.

Chariot Race
Materials One tube or ring buoy per pair
Goal To develop bottom arm strength and propulsive skills for sidestroke
How to Play Conduct this activity in neck-deep or deeper water. Have one person in each pair tow
(with the hand that would be the top arm in the sidestroke) the other who is sitting in
a tube. Stress using free arm to do the movements of the lower arm in the sidestroke.
Have pairs switch at a designated point.
Tip Attach a short rope to tube for those who have trouble towing.
Adaptations Place individuals with visual impairment near the lane line to keep oriented. For an
individual with physical disabilities who cannot tow and swim at same time or who
uses a PFD, use bungee cord to connect tube to PFD, shorten distance, allow more
time, have instructor help pull, or allow another more appropriate movement instead
of sidestroke.
© American Red Cross 1977

(continued)

309
 Are We There Yet?
Materials A large floating foam mat or several foam tubes
Goals 1. To develop leg muscle endurance
2. To develop flutter kick
How to Play Place evenly strong participants on each side of a mat or tube with their upper bodies
draped on it. On signal, have them kick as hard as they can for 30 seconds. Rest and
repeat. It is fun to try to move the mat toward the group on the other side of the mat.
Tips If the game is getting competitive, stand on one side of the mat to hold on, evening
the odds. Or have all the students try to move the mat from one side of the pool to the
other.
Adaptations Put PFD around person with poor head control to act as a head prop. Also stay near
this person.

Poison
Materials Floating objects, such as kickboards, balls, hoops, and tubes (about 5 per participant
in a cordoned-off area)
Goals 1. To improve direction changing
2. To increase alertness when swimming
How to Play Designate all floating items as poison. Have students perform various skills for the
width of the pool and avoid the poison.
Adaptations Use some floating objects that have bells in them. Have an aide tap person with visual
impairment when poison is near. Place some anchored poisons near wall and have
visually impaired swim close to wall.

12-14 Years Old

Rolling Log
Materials None
Goals 1. To improve turning over from back to front
2. To improve motionless front float
3. To improve front crawl or breaststroke speed
How to Play Mark off spaces at opposite ends of the deep end for two goals. Have one player, the
“log,” float on back in the center of the pool midway between the two goals. Have
the other players swim in a circle around the log, who without warning suddenly
rolls over and chases them. Encourage players to try to reach one of the goals without
being tagged. Those caught must join the first log in the center, and when the first log
rolls over, help tag others.
Tips In general, slower swimmers need an equalizer in order to catch someone. Having
those in the circle of swimmers swim underwater can help slow the faster swimmers
down a bit.
Adaptations For students with visual impairment in the group, have log yell “log over,” and you
yell “goal” from the goal area several times for orientation. For students with poor
swim skills, a PFD could be helpful as well as a shorter distance to the goal. Students
with no propulsive skills can grab onto a string in their lap and hold onto it while you
pull them to goal.
From Special Olympics n.d.

310
 Surfin’ USA
Materials One blow-up raft per student (slightly underinflated), tape player with song “Surfin’
USA” by the Beach Boys, diving bricks on the bottom of pool at the halfway point
Goal To improve front crawl and butterfly
How to Play Play “Surfin’ USA” on tape player. Have participants start out lying on raft at one end
of the pool. In waves of three, have them do front crawl arms to a location marked
with a brick on bottom of pool 10 yards away, then surf on raft for 30 seconds, then
resume front crawl arm stroke to other end while next wave begins. Repeat with but-
terfly arms, then flutter and dolphin kicks.
Tips Do not allow students to surf in lanes closest to walls. Do not allow standing surfing in
shallow water. Do not allow diving off the raft.
Adaptations Allow individuals to be creative in surfing (e.g., sit-surfing, knee-surfing, supine-
surfing). For individuals with poor range of motion that limits their ability to reach over
the sides of the raft, use thinner raft or fold sides of raft under and clip.

Strike a Pose
Materials Music that can be started and stopped
Goals 1. To improve stationary sculling
2. To improve treading water
3. To improve motionless float
How to Play Have participants swim in a circle in deep end while music is on; when music is off,
have them strike a pose either treading water, stationary sculling, or floating motion-
lessly. When music is on again, have them swim.
Adaptations Individual with poor vision can swim perimeter of area and stay close to wall and lane
line or have a buddy next to them. You can tap the shoulder of hard-of-hearing or deaf
swimmer with a reaching pole that has a tennis ball impaled on one end. For those
with poor swim skills, allow PFDs and allow them to use the stroke they need the most
work on.

311
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 Appendix D

Information-
Gathering Forms

313
 West Chester University Community
Adapted Aquatics Program

Swimmer’s name: _________________________________________________________________________

Residence: _______________________________________________________________________________

Date of birth: ____________________________________________________________________________

Caregiver at the pool: _____________________________________________________________________

What are the medical issues we need to know about, such as seizures, diabetes, medications, swallow-
ing water, atlantoaxial instability syndrome, toileting issues?

What are five things the swimmer wants to learn?

What are five things the caregiver wants the swimmer to learn?

What are five skills other than swimming that we should encourage?

What are any behavioral issues that we need to address, and how should we address them?

314
 West Chester University Adapted Aquatics Program

Participant information—To be filled out by parents.

Participant’s name: ________________________________________________________________________
Address: _________________________________________________________________________________
Phone number: __________________________ Parent’s or guardian’s name: _______________________
School or program they attend: _____________________________________________________________
Teacher’s or leader’s name: _________________________________________________________________
Address if different from above: _____________________________________________________________
Phone number if different from above: _______________________________________________________
Person to call if emergency: Name ____________________________ Phone ________________________
Participant’s disability: _____________________________________________________________________
Is child subject to seizures?  _____ Yes  _____ No If yes, please describe seizure. Time it usually
lasts? Unconscious? What symptoms before it occurs? Is there anything in particular to avoid?
_________________________________________________________________________________________
_________________________________________________________________________________________
Is child on medication?  _____ Yes  _____ No If yes, what type? __________________________
What (if any) equipment does your child use (e.g., glasses, wheelchair)? ___________________________
What are your child’s likes (food, toys, cartoons, anything)?
_________________________________________________________________________________________
Please share with us the behavior intervention strategies that best work with your child.
_________________________________________________________________________________________
_________________________________________________________________________________________
What are your child’s dislikes? ______________________________________________________________
Is your child on a specific behavior, food, or toileting program that we need to be aware of?
Please explain: ___________________________________________________________________________
_________________________________________________________________________________________
Any other health problems that we should be aware of (e.g., allergies, asthma, and so on)?
_________________________________________________________________________________________
_________________________________________________________________________________________
Statement of release: I understand that West Chester University and the Special Physical Activities Pro-
gram personnel cannot be held directly responsible for any injuries, thefts, and damage to persons or
personal property.
______________________________________________
Signature of parent or legal guardian
______________________________________________
Date
Photo release: On occasion pictures may be taken to promote the program. It is understood that these
pictures will be taken under the supervision of the director and great care will be taken to ensure that
the individual will not be embarrassed by their use.
Permission is granted _____  Permission is not granted _____
For pictures to be taken of _________________________________________________________________
Student’s name
______________________________________________
Signature of parent or legal guardian
______________________________________________
Date

315
 West Chester University Adapted Aquatics Program

Director: Monica Lepore

School Confidential Form
1. Participant’s name: __________________________  2. Date of birth: __________________________
3. Teacher name: _____________________________  4. School phone: _________________________
5. School name: __________________________________________________________________________
6. School address: ________________________________________________________________________

Information concerning the individual (use pen please)

7. Enrolled in a special class?  Yes _____  No _____ 8. Type of class: _________________________
9. Number of years in school: _____________________________________________________________
10. Does he or she participate in an aquatics program at school?  Yes _____  No _____
11. If yes, how many hours per week? _____
12. Comments about individual’s performance in aquatic activities:
______________________________________________________________________________________
_______________________________________________________________________________________
13. Has the child had any motor assessment done?  Yes _____  No _____
14. If yes, identify test used: ________________________________________________________________
_______________________________________________________________________________________
15. Brief description of individual’s relationship and interaction with peers:
_______________________________________________________________________________________
_______________________________________________________________________________________
16. Does the student need a one-on-one working situation in order to function at an acceptable
level?  Yes _____  No _____  Explain ___________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
17. Comments about student’s personality: ___________________________________________________
_______________________________________________________________________________________
18. Is this client on a formal _____ or informal _____ behavior modification program? Explain.
_______________________________________________________________________________________
_______________________________________________________________________________________

Classroom activities
19. Activities the student excels in: _________________________________________________________
20. Activity the student enjoys the most. Individual activity: ____________________________________
21. Group activity: _______________________________________________________________________
22. Motor development or perceptual activities you would suggest that the student work on:
_______________________________________________________________________________________
23. Additional comments: __________________________________________________________________
______________________________________________________________________________________

Filled out by: ______________________________________ Date: _________________________________

Return to: Dr. Monica Lepore
West Chester University
West Chester, PA 19383

316
 This part to be filled out by physical education teacher
Name: ____________________________________________________ Phone: ________________________

Goals for this student for this school year: ____________________________________________________

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

Specific objectives: ________________________________________________________________________

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

Does the student participate in adapted physical education? _____

How much time per week? __________
Is adapted physical education in the IEP? _____
What specific objectives does this student need to learn in order to be more fully able to participate in the
school’s regular physical education program for this year? ______________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

What role do you play in the IEP process? ______________________________________________________

_________________________________________________________________________________________

What assessment is used to determine appropriate placement in physical education?

_________________________________________________________________________________________

Can you share the results of that assessment? ___________________________________________________

_________________________________________________________________________________________

317
 West Chester University Parent or Caregiver
Assumption of Risk Form

Informed Consent and Liability Release

Please fill out and return to: Monica Lepore
West Chester University
Health and Physical Education Center
West Chester, PA 19383

I understand that participation in the West Chester University Children’s Adapted Multiactivities Pro-
gram has risks due to the physical demands that are placed on a child during physical activity and rec-
reation participation, and that during physical activity there is a potential risk of physical injury. I agree
that I am solely responsible for my child’s participation and for his or her physical and emotional well-
being. I understand that the program activities are voluntary and after receiving a copy of the activities,
I am choosing for my child to participate in each activity to whatever degree possible—with the child’s
physical, emotional, and medical considerations considered.
  I affirm that my child’s health is good, and that he or she is not under a physician’s care for any
undisclosed condition that bears upon his or her fitness to participate in physical education, recreation,
and aquatic activities. I willingly and knowingly assume risk for my child, myself, my heirs, family
members, executors, and administrators, and assume all risk of physical injury and emotional upset
that may occur during any aspect of the program; and hereby agree to hold West Chester University, its
employees, instructors, facilitators, and volunteer counselors blameless for any liability arising out of
the child’s participation in the program.
  This release does not, however, apply to any physical injury or emotional harm caused by negligence
or willful misconduct of West Chester University, and the facilitators, employees, instructors, and vol-
unteers of the Children’s Adapted Multiactivities Program.

Date: ____________________________________________________________________________________
Parent or caregiver’s signature: _______________________________________________________________
Address: __________________________________________________________________________________

Please attach proof of insurance to this form for our files.

318
 Appendix E

Adapted Aquatics
Program Resources

Aqua Sphere
Equipment 2340 Cousteau Court
Vista, CA 92081
800-775-3483
Access to Recreation www.aquasphereusa.com
800-634-4351 Active swim equipment, especially eye protection
www.accesstr.com
customerservice@accesstr.com Aquatic Access, Inc.
Pool lifts, beach wheelchairs, shower chairs, 417 Dorsey Way
flotation devices Louisville, KY 40223
800-325-5438
Activeaid, Inc. www.aquaticaccess.com
101 Activeaid Rd. Pool accessibility equipment
P.O. Box 359
Redwood Falls, MN 56283-0359 Aquatic Development Group
507-644-2951 13 Green Mountain Dr.
800-533-5330 P.O. Box 648
www.activeaid.com Cohoes, NY 12047
activeaid@activeaid.com 518-783-0038
Aquatic and shower chairs www.aquaticgroup.com
Moveable pool floors, ramps, tot docks, and so on
AquaJogger
800-922-9544 Aquatic Trends
www.aquajogger.com 800-775-9588
info@aquajogger.com www.aquatictrends.com
Aquatic exercise equipment info@aquatictrends.com
Aquatrend water workout station

319
320 Appendix E

Arjo Hydro-Fit
800-323-1245 160 Madison St.
www.arjo.com Eugene, OR 97402
Pool accessibility equipment 800-346-7295
www.hydrofit.com
Biosig Instruments Inc.
Aquatic exercise and water aerobic equipment
800-463-5470
www.biosiginstruments.com Hydro-Tone Fitness Systems Inc.
biosig@biosig.net 800-622-8663
Aquatic exercise equipment and heart rate www.hydrotone.com
monitors hydrotone@hydrotone.com
Aquatic exercise and therapy equipment
D.K. Douglas Company
800-333-9070 Kiefer
www.wetwrap.com 800-323-4071
wetwrap@wetwrap.com www.kiefer.com
Water wear: Wet Wrap, WetPants esales@kiefer.com
Swimwear, pool and safety equipment
Dacor
161 Northfield Rd. Life Jacket—Adapted Inc.
Northfield, IL 60093 780-939-2466
203-852-7079 www.pfd-a.com
www.divedacor.com info1@pfd-a.com
dacor@us.head.com
Marine Rescue Products
Recreational aquatics and snorkeling equipment
800-341-9500
Danmar Products, Inc. www.marine-rescue.com
221 Jackson Industrial Dr. Lifeguard and pool safety equipment
Ann Arbor, MI 48103
New England Fitness Company
800-783-1998
800-452-0980
www.danmarproducts.com
www.nefitco.com
Swimmer aids and instructional equipment
customersupport@nefitco.com
Excel Sports Science, Inc. Aquatic exercise equipment
4048 W. 1st Avenue, Suite B
Polar
Eugene, OR 97402-9391
800-227-1314
Swim equipment
www.polarusa.com
Ferno Performance Pools customer.service.usa@polar.fi
888-206-7802 Heart rate monitors
www.fernoperformancepools.com
Recreonics
info@fernoperformancepools.com
800-428-3254
AquaCiser underwater treadmill
www.recreonics.com
Finis aquatics@recreonics.com
888-333-4647 Pool lifts and accessibility equipment
www.finisinc.com
Rehabmart
info@finisinc.com
800-827-8283
Training equipment for the swim industry
www.rehabmart.com
FlagHouse order@rehabmart.com
800-793-7900 Aquatic rehabilitation aids and instructional
www.flaghouse.com equipment
Aquatic and exercise equipment for special
populations
 Appendix E 321

Speedo WinTech
6040 Bandini Blvd. 345 Wilson Ave.
Los Angeles, CA 90040 Norwalk, CT 06854
888-4-SPEEDO www.wintechracing.com
www.speedousa.com chawkins@wintechracing.com
Consumers@SpeedoUSA.com Rowing
Aquatic apparel and accessories
WMS Aquatics
Spectrum Products 800-426-9460
800-791-8056 www.wmsaquatics.com
www.spectrumproducts.com info@wmsaquatics.com
info@spectrumproducts.com Pool accessibility equipment
Pool and accessibility equipment
World Wide Aquatics
Sportime 866-689-9333
P.O. Box 922668 www.worldwideaquatics.com
Norcross, GA 30010-2668 Swimwear, pool equipment, Speedo aquatic exercise
800-283-5700 step
www.sportime.com
Flotation and safety products
Organizations
Sprint Rothhammer International, Inc.
800-235-2156
www.sprintaquatics.com Access to Sailing
info@sprintaquatics.com www.accesstosailing.org
Aquatic exercise equipment and DVDs info@accesstosailing.org
562-433-0561
Swim Ways
5816 Ward Court American Alliance for Health, Physical Education,
Virginia Beach, VA 23455 Recreation and Dance
757-460-1156 (AAHPERD and AAPAR Adapted Aquatics
800-889-7946 credentials)
www.swimways.com www.aahperd.org
Swim toys and floats info@aahperd.org
703-476-3400
Triad Technologies 800-213-7193
800-729-7514
www.triadtec.com American Canoe Association (ACA)
Swimming pool access, storage, and seating www.acanet.org
products aca@americancanoe.org
703-451-0141
Water Gear
P.O. Box 759 American Red Cross (ARC)
Pismo Beach, CA 93448 www.redcross.org
800-794-6432 800-733-2767
www.watergear.com American Swimming Coaches Association
Competitive, recreational, and aqua-aerobics gear www.swimmingcoach.org
Whitmer Company, The asca@swimmingcoach.org
216-749-4350 800-356-2722
800-362-1162 American Therapeutic Recreation Association
www.whitmer.com www.atra-tr.org
whitmer@whitmer.com atra@atra-tr.org
Pool accessibility equipment 703-683-9420
322 Appendix E

America’s Athletes With Disabilities International Swimming Hall of Fame

www.americasathletes.org www.ishof.org
info@americasathletes.org 954-462-6536
301-589-9042
Jeff Ellis and Associates Inc.
Aquatic Exercise Association (AEA) www.jellis.com
www.aeawave.com 800-742-8720
info@aeawave.com
Mission Bay Aquatic Center
941-486-8600
www.missionbayaquaticcenter.com
888-232-9283
mbac@sdsu.edu
Aquatic Resources Network 858-488-1000
www.aquaticnet.com
National Association of Underwater Instructors
info@aquaticnet.com
(NAUI)
715-248-7258
www.nauiww.com
Aquatic Therapy and Rehabilitation Institute (ATRI) nauihq@nauiww
www.atri.org 800-553-6284
atri@atri.org
National Center on Accessibility
866-462-2874
www.ncaonline.org
Australian Sports Commission nca@indiana.edu
www.ausport.gov.au 812-856-4422
asc@ausport.gov.au TTY: 812-856-4421
612-6124-1111
National Center on Physical Activity and Disability
Disabled Sports USA www.ncpad.org
www.dsusa.org ncpad@uic.edu
programs@dsusa.org 800-900-8086
301-217-3960
National Disability Sports Alliance (NDSA)
Dwarf Athletic Association of American www.ndsaonline.org
www.daaa.org info@ndsaonline.org
daaa@flash.net 401-792-7130
972-317-8299
National Instructors Association for Divers with
Fédération Internationale de Natation (FINA) Disabilities
www.fina.org www.niadd.org
+41-21-310-47-10 831-633-3006
Handicapped Scuba Association International National Intramural-Recreation Sports Association
www.hsascuba.com www.nirsa.org
has@hsascuba.com nirsa@nirsa.org
949-498-4540 541-766-8211
IDEA Health and Fitness Association National Recreation and Park Association (NRPA)
www.ideafit.com www.nrpa.org
contact@ideafit.com info@nrpa.org
800-999-4342 703-858-0784
International Paralympic Committee—Swimming National Safety Council
www.ipcswimming.org www.nsc.org
anne.ipcswimming@bigpond.com info@nsc.org
+61-8-9355-5517 630-285-1121
International Sports Federation for Persons with National Therapeutic Recreation Society (NTRS)
Intellectual Disability (INAS-FID) www.nrpa.org (search NTRS division)
www.inas-fid.org ntrsnrpa@nrpa.org
info@inas-fid.org 703-858-0784
+46-278-62-60-67
 Appendix E 323

Open Waters Project United States Sailing Association (US Sailing)

www.alpha-one.org Sailors with Disabilities division
800-640-7200 www.ussailing.org/swsn
info@ussailing.org
Professional Association of Diving Instructors
800-877-2451
(PADI)
www.padi.com United States Synchronized Swimming, Inc.
800-729-7234 www.usasynchro.org
317-237-5700
Shake-A-Leg
www.shakealeg.org USA Deaf Sports Federation (USADSF)
shakealeg@shakealeg.org www.usdeafsports.org
401-849-8898 homeoffice@usdeafsports.org
605-367-5760
Special Olympics
TTY: 605-367-5761
www.specialolympics.org
info@specialolympics.org USA Swimming
202-628-3630 www.usaswimming.org
719-866-4578
SwimAmerica
www.swimamerica.org USA Water Ski
800-356-2722 www.usawaterski.org
usawaterski@usawaterski.org
U.S. Paralympics
863-324-4341
www.usolympicteam.com/paralympics
paralympicinfo@usoc.org Wheelchair Sports, USA (WSUSA)
719-866-2030 www.wsusa.org
wsusa@aol.com
United States Aquatic Association of the Deaf
732-422-4546
(USAAD)
www.members.tripod.com/USAAD World Congress and Exposition on Disability
USAADeaf@yahoo.com www.wcdexpo.com
V/TTY: 410-664-3727 sales@wcdexpo.com
201-226-1446
United States Association of Blind Athletes (USABA)
www.usaba.org World Waterpark Association
media@usaba.org www.waterparks.org
719-630-0422 memberservices@waterparks.org
913-599-0300
United States Masters Swimming
www.usms.org Young Men’s Christian Association (YMCA)
800-550-SWIM of the USA
www.ymca.net
U.S. Rowing Association (USRowing)
800-872-9622
www.usrowing.org
members@usrowing.org
800-314-4769 Publications, Programs, and
United States Swim School Association Videos
www.usswimschools.org
info@usswimschools.org
480-837-5525 Adapted Aquatics Teacher Training
Peter Gregory Angelo, PhD
United States Water Fitness Association (USWFA) Department of Physical Education and Athletics
www.uswfa.com The State University of New York at Stony Brook
info@uswfa.org www.sinc.sunysb.edu/class/adapted/prod01.html
561-732-9908 Video
324 Appendix E

Adapted Physical Activity Quarterly (APAQ) Journal of Aquatic Physical Therapy

www.HumanKinetics.com/APAQ 303-694-4728
Journal www.aquaticpt.org
aquaticpt@assnoffice.com
Aquatics International
Journal
323-801-4983
www.aquaticsintl.com Pool and Spa News
Journal 888-269-8410
www.poolspanews.com
Aquatics Therapy Programming for Orthopedic
Magazine
Rehabilitation
Joanne M. Koury, MEd (1996) Swimming World Magazine
Champaign, IL: Human Kinetics www.swimmingworldmagazine.com
Text Magazine
Parkinson’s Aquatic Fitness Training The Aquatic Therapist
Arthritis Foundation Aquatic Program www.aquaticnet.com
Fibromyalgia Interval Training (For more contact information, see listing on page
Aquatic Therapy for Polio Survivors 321 for the Aquatic Resources Network)
Sprint Aquatics (2006) Journal
800-235-2156
Water Exercise
www.sprintaquatics.com
Martha D. White, OTR (1995)
info@sprintaquatics.com
Champaign, IL: Human Kinetics
DVD series
Text
Fantastic Water Workouts
Water Fitness After 40
MaryBeth Pappas Gaines (1993)
Ruth Sova (1995)
Champaign, IL: Human Kinetics
Champaign, IL: Human Kinetics
Manual
Text—paperback
Fitness Aquatics
LeAnne Case (1997)
Champaign, IL: Human Kinetics
Manual
Introduction to Adapted Aquatics
Monica Lepore, EdD (2006)
Sprint Aquatics
800-235-2156
www.sprintaquatics.com
info@sprintaquatics.com
DVD

AAPAR Levels of
Adapted Aquatics
Credentials
American Association for Physical Activity and Rec-
reation (AAPAR) is an association of the American
Association for Health, Physical Education, Recre-
ation and Dance.
Adapted Aquatics Instructor
The Adapted Aquatics Instructor (AAI) course trains
professionals to teach swimming and water safety skills
to individuals with disabilities. AAIs are credentialed
to teach participants with disabilities and the Adapted
Aquatics Assistant course. A credential is a nonexpiring
document like a diploma that documents the successful
acquisition of skills, knowledge, and attitudes related to
adapted aquatics. As always, a certified lifeguard must
be on deck with the sole responsibility of lifeguarding
during any adapted aquatics program.
Prerequisites
• Age 18 or older
Appendix F
• Current nationally recognized certification
(ARC, YMCA, E&A, SwimAmerica, or equiva-
lent) in teaching swimming; lifeguard instructor,
scuba instructor, or coaching certificates are not
acceptable to meet this prerequisite
• Current first aid certificate from a nationally rec-
ognized organization (National Safety Council,
ARC, or equivalent)
• Current CPR certificate including infant, child,
and adult cardiopulmonary resuscitation plus
AED from a nationally recognized organiza-
tion (ARC, American Heart Association, or
equivalent)
• For a weekend course, documented experience
with individuals with disabilities (minimum 5
hours)
• Sufficient strength to independently support a
125-pound (56.7-kilogram) person in the water
and be part of a two-person team to transfer a
125-pound (56.7-kilogram) person in and out
of a pool in an emergency
325
326 Appendix F
Course Instructor
This course is taught by a Master Teacher of Adapted
Aquatics.
Course Length
The course runs for a minimum of 20 to 24 hours.
These hours include at least 2 of the 3 practicums
(which are explained in the sections below), assign-
ments, and the exam. These hours exclude the pre-
requisite 5 hours.
Course Text
Lepore, M., Gayle, G.W., & Stevens, S. (2007).
Adapted aquatics programming: A professional guide
(2nd ed.). Champaign, IL: Human Kinetics. ISBN 0-
7360-5730-7; ISBN-13 978-0-7360-5730-1. Students
must order their own books. It is available through the
AAHPERD catalog at a discount for members who call
800-321-0789 or fax their order to 301-567-9553. You
may also purchase the book through the AAHPERD
online store at www.aahperd.org. If unavailable,
contact Human Kinetics on their Web site at www.
HumanKinetics.com or call 800-747-4457 to order
the book. The course text is required for all partici-
pants, as the course exam is based on this text.
Adapted Aquatics Adjunct
The Adapted Aquatics Adjunct (AAAdj) credential
prepares professionals who have professional certi-
fications in related areas such as special education,
physical education, adapted physical education,
physical therapy, occupational therapy, and thera-
peutic recreation to work under the supervision of,
or in conjunction with, a credentialed AAI in aquatics
programs that provide swim and water safety instruc-
tion to individuals with disabilities. People possessing
the AAAdj credential must work in conjunction with
a credentialed AAI or certified Water Safety Instructor
(WSI), and this credential does not suggest that this
professional can solely conduct an adapted aquatics
program.
The AAAdj is not a separate course. It is a separate
credential for professionals who have all the prereq-
uisites for the AAI course except the WSI credential
and who possess a professional license, certification,
or diploma in one of the disciplines listed above and
who have successfully completed all the requirements
and final exam.
Prerequisites
• Age 18 or older
• Proof of professional certification in a related
area such as special education, physical edu-
cation, adapted physical education, physical
therapy, occupational therapy, and therapeutic
recreation
• Successful completion of the following swim
test: Jump into deep water, tread water for 2
minutes (hands may be used), swim 10 yards
(9.1 meters) using a stroke in a prone posi-
tion, reverse direction and return 10 yards (9.1
meters) to the starting area using a stroke in the
supine position, all without stopping or resting
during this test
• Current first aid certificate from a nationally
recognized organization (ARC, National Safety
Council, or equivalent)
• Current CPR certificate including infant, child,
and adult cardiopulmonary resuscitation plus
AED from a nationally recognized organiza-
tion (ARC, American Heart Association, or
equivalent)
• For a weekend course, documented experience
with individuals with disabilities (minimum 5
hours)
• Sufficient strength to independently support a
125-pound (56.7-kilogram) person in the water
and be part of a two-person team to transfer a
125-pound (56.7-kilogram) person in and out
of a pool in an emergency
Course Length
Same as that for AAI course
Course Text
Same as that for AAI course
Course Content
Same as that for AAI course; the course objectives
slightly differ to account for the lack of standardized
knowledge of instructional swimming strategies and
safety.
All course materials are the same as those for the
AAI course. All lectures and experiences are the same.
Candidates for the AAAdj should be paired with a WSI
at all times during the in-water experiences.
 Appendix F 327

Practicums
Candidates for the AAAdj credential must partici-
pate in the same practicum as the AAI candidates.
During the practicum, the AAAdj candidate must be
paired with and work in collaboration with the AAI
candidate.
Course Exam
At the completion of the course all AAAdj candidates
must take the closed-book AAI credentialing exam.
All requirements for the exam are the same as those
listed in the AAI section.
Course Completion
Same as for the AAI credential
Adapted Aquatics Assistant
The Adapted Aquatics Assistant (AAA) credential
prepares individuals to work under the supervision of
a credentialed AAI in aquatics programs that provide
swim and water safety instruction to individuals with
disabilities.
Prerequisites
• Age 14 or older
• Successful completion of the following swim
test: Jump into deep water, tread water for 2
minutes (hands may be used), swim 10 yards
(9.1 meters) using a stroke in a prone posi-
tion, reverse direction and return 10 yards (9.1
meters) to the starting area using a stroke in the
supine position, all without stopping or resting
during this test
Course Length
Minimum of 12 hours
Course Instructor
AAIs and Master Teachers of Adapted Aquatics may
teach this course.
Course Text
Same as that for the AAI course
Course Exam
At the completion of the course all credentialing stu-
dents must take the closed-book credentialing exam.
This page intentionally left blank.

acquired immune deficiency syndrome (AIDS)—The outcome
of HIV infection, causing high susceptibility to all kinds of
bacterial and viral infections due to an inadequate immune
system.
active-assistive ROM—Active ROM exercise in which assistance
is provided by an outside force.
active learning time (ALT)—The amount of time a student spends
engaged in appropriately challenging, on-task learning
behavior.
active ROM—Movement within ROM initiated and performed
by contraction of the muscles; active ROM is not aided by
another person.
adapted aquatics—A comprehensive label for programs serving
individuals with disabilities that use swimming, water safety,
and aquatic recreational activities to promote health and
rehabilitation. Such programs encompass more than teaching
swim strokes but do not include therapeutic water exercise,
hydrotherapy, or aquatic therapy.
adapted physical education (APE)—Any adaptation to the physical
education curriculum, including specially designed instruction,
that allows for safe, successful, and satisfying participation of
a student with a disability.
adapted swimming—A program that modifies swim strokes for
individuals who do not have the strength, flexibility, or endur-
ance to perform the standard version. Adapted swimming is
part of adapted aquatics.
adapted water exercise—Water exercise is a program that entails
active (not passive) exercises typically performed on land into
the medium of a pool. In adapted water exercise, these active
exercises are adapted to the needs of individuals with acute
or chronic disabilities.
adduction—Movement of the extremities toward the body mid-
line.
Alzheimer’s disease—A disability of unknown origin primarily
affecting the older population; it may involve a variety of symp-
toms ranging from mild memory loss to profound disorientation
and from passivity to aggression. Symptoms may also include
physical disabilities.
ambulation—Walking with or without assistance.
American Alliance for Health, Physical Education, Recreation and
Dance (AAHPERD)—The foremost association for health and
physical educators, encompassing over 35,000 professionals.
AAHPERD is the parent organization of AAPAR, under which
the Council for Aquatic Professionals administers the AAI
credential.
American Red Cross—The nation’s premier emergency response
organization. ARC also collects, processes, and distributes
Glossary
blood and blood products; offers community services that help
the needy, provide support for military families, and promote
health and safety education; and participates in international
relief and development programs.
Americans with Disabilities Act (ADA) (PL 101-336)—Federal law
that expanded federally mandated accessibility and participa-
tion requirements of the Vocational Rehabilitation Act of 1973,
Section 504, to the private sector.
amputated limb—A limb (partial or full) that is missing from the
body, either from birth or from amputation occurring later in
life.
anemia—A blood disorder characterized by reduced oxygen
delivery to tissues.
annual goals—Global statements that provide direction for
instruction.
aphasia—Loss of or impaired expression or comprehension of
spoken or written language.
aquatic therapy—Water exercise that has been prescribed by a
physician or therapist.
arthritis—Inflammation of the joints and concurrent damage to
the various articulating surfaces within the joints.
arthrogryposis—A nonprogressive disorder that affects many of
the joints, making them weak, stiff, and swollen. Joint angles
may be atypical; intelligence is usually normal. This disorder
is also known as multiple congenital contractures.
assessment—Gathering and interpreting data to develop a student
profile influencing placement, goals, and objectives.
asthma—A respiratory condition in which either exercise or
allergens induce bronchial inflammation and increased mucus
production, leading to wheezing, coughing, difficulty exhaling,
shallow breathing, feelings of chest constriction, and difficulty
regulating breathing.
ataxia—A descriptive term meaning poor balance and general lack
of coordination; ataxia is also a type of cerebral palsy.
atlantoaxial instability—Unstable joint at cervical vertebrae 1
and 2. When the head is bent forward, the spinal cord can be
pinched (Bleck & Nagel, 1982).
atrophy—Reduction of tissue due to disease or injury.
attention deficit disorder (ADD)—A difficulty focusing on tasks,
distractibility, or a difficulty attending to directions.
attention deficit hyperactivity disorder (ADHD)—ADD com-
bined with hyperactivity, which leads to fidgeting, impulsiv-
ity, excessive movement, impatience, and low tolerance for
frustration.
autism—A pervasive developmental disability, typically revealed
before the age of 30 months, in which interaction with people is
329
330 Glossary
impaired, activity level is significantly above or below average,
and eye contact is minimized. People with this disorder may
engage in echolalia, exhibit no fear of real dangers, engage in
odd play, or display inappropriate attachments to objects.
behavior disorder—A behavior that is exhibited over a long time
and to a marked degree, adversely affecting learning. Severe
behavior disorders include noncompliant, self-stimulatory,
self-abusive, and aggressive behavior. People with behavior
disorders may also be described as being emotionally disturbed
or socially maladjusted.
behavior modification—Changing behavior via the systematic
application of methods of behavioral science.
blindness—A lack of sight that is severe enough that a person
cannot see shapes, shadows, or light. Various terms, such as
total, low-partial, and high-partial blindness, describe visual
impairment of one degree or another.
bromine—A chemical agent often used in cleaning pool water.
bursitis—An inflammation of the bursae sacs that results from
repeated irritation with overuse or from direct trauma. Bursae
help cushion a joint.
cancer—An abnormal reproduction of atypical cells that leads
to tumors. Chemotherapy and radiation therapy treatments
are common.
cardiorespiratory system—System that transports oxygen from the
lungs, through the heart, and to the body by the blood vessels;
includes the heart, blood vessels, and lungs.
center of buoyancy—The area of the body around which buoyancy
is evenly distributed; generally located in the chest region.
cerebral palsy—A general term applied to nonprogressive, neuro-
muscular disorders affecting normal, orderly motor develop-
ment and voluntary muscle control. These disorders are caused
by a brain lesion before, during, or shortly after birth. Common
types are ataxia, athetosis, spastic, flaccid, and tremor.
chondromalacia—A condition in which the underside of the
kneecap degenerates, causing bone erosion and pain (Torg,
Welsh, & Shephard, 1990).
conjunctivitis—Inflammation of the membrane lining the eyelid
and the eyeball.
continuum of alternative placements—The provision of successive,
hierarchical placements in order to achieve or approximate the
least-restrictive environment (LRE). Settings may be inclusive
or segregated.
continuum of support—The identification and implementation of
services provided through the inclusion setting, such as equip-
ment, personnel, or instructional support.
contraindication—An activity or treatment considered undesir-
able, unwarranted, or improper because of possible deleteri-
ous effects.
coping behaviors—Techniques utilized by individuals to avoid
learning or practicing what is being taught.
Data-Based Gymnasium (DBG) Program—Noncategorical teach-
ing approach using task analysis, data recording, and behavioral
principles.
Deafness—Severe hearing loss in which a person cannot under-
stand speech even with a hearing aid; also a cultural minority
that uses sign language as a communication medium.
decubitus ulcer—A lesion of the skin and tissue that results in
death to the tissue and breakdown of the skin.
diabetes—A metabolic disorder in which the body does not pro-
duce or underproduces insulin, preventing body cells from
using sugars for energy.
Down syndrome—A congenital disorder in which there is an extra
chromosome on the 21st pair. Common characteristics are short
stature, cognitive impairment, speech and language disorders,
congenital heart defects, visual and hearing impairments, flat
feet, lax ligaments, low muscle tone, joint instability, and,
sometimes, atlantoaxial instability.
dry ramp—A pool access constructed into the pool deck outside
of the pool.
ecologically based assessment—An assessment that considers
the skills needed in the individual’s current and future envi-
ronments.
Education for All Handicapped Children Act of 1975 (PL 94-
142)—A law that ensures a free and appropriate public edu-
cation in the least-restrictive environment, including special
education and related services, for all handicapped children
aged 3 to 21 years.
Education for All Handicapped Children (reauthorization of 1980)
(PL 99-457)—Amendment to PL 94-142 that mandates and par-
tially funds services for handicapped children down to age 3.
expressive language—Expressing with words in a meaningful,
organized way.
fetal alcohol syndrome—A condition in which a fetus is prena-
tally exposed to alcohol through the mother’s alcohol abuse.
Symptoms include small size for age, abnormal muscle tone,
developmental delays, and abnormal alertness, attention, and
learning. It is a leading cause of intellectual disability.
flexibility—The ability of a muscle to relax and stretch.
germicide—An agent that kills disease-producing microorgan-
isms.
hard of hearing—A classification of hearing loss in which a person
can understand linguistic information by using amplifiers and
hearing aids.
heart defects—Malformations of the heart, which can be con-
genital or acquired and can hamper an individual’s ability to
become or remain fit.
hemiplegia—Paralysis on one side of the body.
hemophilia—A blood disorder in which the protein needed to
clot blood is lacking, leading to internal or external bleeding
or both. Internal bleeding into joints (hemarthrosis) can cause
joint dysfunction.
homeostasis—Regulation of balance of internal bodily functions;
a state of internal equilibrium.
hydrocephalus—An accumulation of cerebrospinal fluid on the
brain, causing enlargement of the head and pressure on the
brain. Excessive brain pressure causes cognitive impairments.
Hydrocephalus is often seen in individuals with myelomenin-
gocele spina bifida.
hydrotherapy—The treatment of disease, disability, and ill health
using water as the therapeutic medium.
hyperthermia—Dangerously high core body temperature.
hypertonicity—Muscle tone that is too high (tight).
hypokinetic diseases—Diseases that result from a lack of physi-
cal activity.
hypothermia—Dangerously low core body temperature.

inclusion—The concept that individuals with disabilities should be
educated and participate in education alongside people without
disabilities and have the necessary supports to do so.
Individualized Educational Program (IEP)—A written plan of
instruction, including present level of performance; annual
goals and objectives; and extent of inclusion, for students
qualifying for special education services.
Individualized Family Service Program (IFSP)—A written plan
describing the educational, therapeutic, and social services
projected for infants, toddlers, and children up to 5 years of
age with a diagnosed disability or with a high risk of having a
permanent disability.
Individualized Transition Plan (ITP)—A statement in the IEP of each
child 16 years or younger describing the process that will be
used to make the transition into community-based living. At 14
years of age, the IEP team begins to consider these goals.
Individuals with Disabilities Education Act (IDEA) (PL 101-
476)—Amendment to 94-142 that changed the name of the
law, added the requirement of having transition plans by age
16, and added autism and traumatic brain injury as disability
categories.
juvenile rheumatoid arthritis (JRA, Still’s disease)—Inflammation
of many joints throughout the body that appears in childhood.
Often symptoms decrease 10 years after onset, but some
children may have chronic joint damage and severe disability
into adulthood.
kinesiotherapy—Profession practiced by certified individuals who
seek to improve work, leisure, and fitness performance through
therapeutic exercises.
kyphosis—A posture problem in which the muscles of the upper
back are weak, causing poor extension of the upper back and
leading to a humpbacked appearance.
lateral movement—Movement oriented to the right or the left or
away from the midline of the body.
learning disability—A dysfunction in one or more of the psycho-
logical processes involving written or spoken language that
is not caused by deafness, blindness, mental retardation, or
environmental disadvantage.
least-restrictive environment (LRE)—The philosophy that children
with disabilities will be provided educational services indi-
vidually determined to be the best place for the child to learn
and to the maximum extent appropriate alongside children
without disabilities.
legal blindness—A loss of vision that equals a visual acuity of
20/200 or worse (with correction) in the better eye or a field
of vision of 20° or less.
les autres—A term meaning the others that includes disabilities
other than spinal cord injury, cerebral palsy, closed head injury,
stroke, amputation, visual impairment, mental impairment, or
hearing disability.
lordosis—A postural problem (swayback) in which the lumbar area
is hyperextended due to weak abdominal muscles or tight hip
flexors and low-back muscles.
mental retardation—Substantial limitations in daily functioning
due to intellectual functioning that is significantly lower than
average, with limitations in two or more of the following: com-
munication, self-care, home living, social skills, self-direction,
health and safety, functional academics, and abilities to pursue
leisure, use the community, and perform work (American
Glossary 331
Association on Mental Retardation [AAMR], 1992). Mental
retardation manifests itself during childhood and is currently
referred to as intellectual disability.
multiple disabilities—The existence of more than one impairment,
such as cerebral palsy combined with blindness or spina bifida
combined with mental retardation, which causes profound
problems in learning (Federal Register, 2006).
multiple sclerosis—A progressive disorder of the nervous system
characterized by degeneration of the myelin sheath surround-
ing the nerves. Onset usually occurs in young or middle-aged
adults, and its cause is unknown. This disorder affects more
women than men.
muscular dystrophy—The name for a group of degenerative dis-
orders affecting muscle tissue and causing atrophy, weakness,
and severe physical disability.
myelomeningocele—A severe type of spina bifida in which the
spinal cord and its covering are herniated through the poste-
rior part of the vertebrae, causing paralysis in the body parts
below the herniated site; the hernia is most commonly located
in the lumbosacral (low-back) region with accompanying
paraplegia.
neurology—Branch of medicine that deals with the nervous system
and its diseases.
obesity—A condition characterized by the excessive accumula-
tion and storage of fat in the body; females weighing 30% to
35% and males weighing 20% to 25% more than the expected
weight for their height and body frame size are classified as
obese. A person who weighs 50% more than the expected
weight for his height and frame size is classified as superobese
(Jansma & French, 1994).
objectives—Measurable intermittent steps by which to plan and
evaluate instruction.
occupational therapy—Use of purposeful activity by licensed
occupational therapists to assist individuals in acquiring the
skills necessary to perform activities of daily living (ADLs).
orthostatic hypotension—A drop in blood pressure that occurs
while a person is vertical and is associated with dizziness and
blurred vision.
orthotic—An orthopedic appliance, such as a brace or other
support.
osteogenesis imperfecta—A condition of brittle bones with several
classifications, in which individuals may or may not have skel-
etal deformities, may or may not be ambulatory, and may or may
not have normal life expectancy (Blauvelt & Nelson, 1994).
paralysis—Loss or impairment of motor function due to a lesion
of the neural or muscular system.
paraplegia—Loss of voluntary muscle control in the lower extremi-
ties.
passive ROM—Movement within the unrestricted ROM that is
produced by an external force rather than the participant
voluntarily contracting the muscle.
peer tutors—Personal assistants who are the same age as the
individuals with disabilities that they help.
personal flotation device (PFD)—Life jackets and similar devices
graded according to buoyancy ability.
physical therapy—Profession practiced by licensed physical thera-
pists that uses heat, cold, electric stimulation, exercise, water,
and massage to improve an individual’s physical functioning.
332 Glossary
placement—The process of matching the person with the program
that best meets their needs, based on assessment criteria and
input from the swimmer and significant others.
plantar fasciitis—Inflammation of the connective tissue on the
underside of the foot that attaches the toes to the heel bone.
The inflammation results in pain and tenderness while walking
and running, often due to tight calf muscles (Robbins, Powers,
& Burgess, 1991).
poliomyelitis—An acute phase of inflammation of the gray matter
of the spinal cord, causing loss of voluntary muscle control and
thus long-term disability.
postpolio syndrome—A variety of characteristics commonly seen
in individuals older than 50 years who have had polio since
childhood. Symptoms include joint dysfunction, paralysis or
paresis, and brittle bones.
Prader-Willi syndrome—A genetic condition marked by mental
retardation, low muscle tone, short stature, and obesity (Wiede-
mann, Kunze, Grosse, & Dibbern, 1992).
preservice—The training of professionals before their immersion
or employment in the field of aquatics.
prone—Lying on the front side of the body.
proprioceptive sensory input—Components of the nervous system
that transmit information between the brain and the muscles,
joints, and ligaments to let an individual know where the body
is in space.
prosthetics—Artificial substitutes for a missing body part.
quadriplegia—Loss of voluntary muscle control in all extremities.
range of motion (ROM)—The amount of motion that occurs
between any two bones in a joint.
rating of perceived exertion (RPE)—A technique in which a person
measures exercise intensity by assigning a number (from 6 to
20) to the intensity that he believes he is working at.
readily accessible—Used in connection with the ADA to describe
the relative ease of entering and using a facility.
readily achievable—Used in connection with the ADA to describe
the relative ease or difficulty of removing barriers from a
facility.
receptive language—Process of organizing and deriving meaning
from sound that is heard.
Rehabilitation Act of 1973 (PL 93-112, Section 504)—A federal
civil rights law prohibiting discrimination based on disability
within any facility or program that is federally funded. It man-
dates accessibility and equal opportunity.
rheumatology—Branch of medicine that deals with rheumatic
disorders such as rheumatoid arthritis.
risk management—Interventions an organization uses to iden-
tify, evaluate, eliminate, reduce, and transfer risks related to
accidents, unsafe facilities and equipment, legal recourse,
inadequate staff, and other related problems.
scoliosis—A posture disorder resulting in a C- or S-lateral (side-
to-side) curve in the spine.
seizure—A characteristic of epilepsy manifested by a disturbance
in the electrochemical activity of the brain, possibly resulting in
unconsciousness and uncontrolled muscular contractions.
seizure disorder—Any of a number of convulsive and noncon-
vulsive disorders frequently associated with epilepsy. Gener-
alized (grand mal) seizures involve involuntary tensing (tonic
phase) and then jerking (clonic phase) of the muscles of the
whole body. Other types of seizures are partial, unilateral,
and unclassified.
sensory integration—The process whereby an individual develops
awareness, discrimination, and recognition of sensory stimuli
and subsequently uses the sensory information to direct motor
behavior.
shin splint—A condition characterized by pain in the front lower
leg as a result of a sudden return to weight-bearing, high-impact
exercise after a layoff (Robbins, Powers, & Burgess, 1991).
spasticity—Abnormally high tension in a muscle.
spina bifida—A congenital neural tube defect, which can be mild
(SB occulta) with no disability, severe (SB myelomeningocele),
or not as severe (SB meningocele). See myelomeningocele for
more information.
station method—A method of teaching in which participants are
directed to specific stations for instruction in specific swimming
skills, permitting focused practice and review.
stimulants—Agents that arouse or produce systemic excitation.
stoma—A surgical opening in an individual’s neck through which
the individual breathes.
stress fracture—The fracture of a bone due to the accumulated
stress of repeated actions. Frequent sites of these microscopic
breaks are the lower leg and foot.
stroke (cerebrovascular accident)—A lack of oxygen to a part
of the brain due to blood vessel occlusion, hardening of the
arteries, embolism, tumor, or aneurysm rupture. A stroke can
cause hemiplegia, speech and language disorders, and per-
manent disabilities.
subluxation—Incomplete or partial dislocation of a joint.
supine—Lying on the back or with the face upward.
tactile instruction—Touch or the method of instruction in which
the aquatics instructor uses hand-over-hand touch to move a
person’s body through an action.
target heart rate zone (THRZ)—A range in which a person should
maintain her heart rate (beats per minute) in order to achieve
cardiorespiratory training effects.
task analysis—A method of breaking down a task to determine its
sequential components.
tendinitis—Inflammation of tendon (soft tissue that connects
muscle and bone) due to repeated stress; can occur at any
joint. Tendinitis often occurs in the Achilles tendon and in
the shoulder.
tenodesis—The use of wrist extension, by people with quadriple-
gia, to passively put the fingers into flexion; can be used for
functional hand grasp (Lockette & Keyes, 1994).
terminal behavior—Behavior targeted for an individual to
achieve.
therapeutic recreation—Health-related profession that seeks to
bring about a change in behavior or function through recre-
ational experiences.
therapeutic water exercise—Aquatic movements specially pre-
scribed for a particular individual. Therapeutic water exercise
protocols should be authorized by a physician and conducted
by a physical therapist, athletic trainer, or kinesiotherapist who
has aquatics training.
therapy hands—The efficacious use of touching, supporting, posi-
tioning, and handling of people to facilitate greater movement
potential (Cratty, 1989).

transdisciplinary approach—In the context of service delivery, the
transdisciplinary approach focuses on sharing and cooperation.
The team of professionals, the caregivers, and the participant
collaborate to prioritize goals and provide input.
traumatic brain injury—An injury to the brain due to a closed
or penetrating (open) head injury that causes multiple dis-
abilities.
traumatic spinal cord injury—Trauma occurring to the vertebrae,
the spinal cord, or both that results in a loss of sensation and
voluntary motor control. The injury can be mild (a broken
Glossary 333
vertebra), which may result in temporary paralysis, or severe
(severed spinal cord), which results in permanent paralysis from
about the site of the injury downward.
vasoconstriction—Narrowing, or constriction, of the blood ves-
sels.
vasodilation—Enlargement of the blood vessels.
ventilator—Mechanical device that assists or performs ventilation
of the lungs.
wet ramp—A pool access connecting the deck directly to the
pool.
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disabilities (3rd ed.). Upper Saddle River, NJ: Merrill.
WHO. (1946). Constitution of the World Health Organization. In
Basic documents (37th ed., p. 2). Geneva: WHO. (Available
at www.who.int)
WHO. (2004). Constitution of the World Health Organization.
Retrieved December 5, 2004, from www.who.int.
Wiedemann, H.R., Kunze, J., Grosse, F.R., Dibbern, H. (1992). An
atlas of clinical syndromes: A visual aid to diagnosis for clini-
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Wilbur, R.H., Finn, S.K., & Freeland, C.M. (Eds.). (1994). The com-
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Wilmore, J.H., & Costill, D.L. (2004). Physiology of sport and
exercise (3rd ed.). Champaign, IL: Human Kinetics.
Winnick, J.P. (1987). An integration continuum for sport participa-
tion. Adapted Physical Activity Quarterly, 4, 157-191.
References 343
Winnick, J.P. (Ed.). (1995). Adapted physical education and sport
(2nd ed.). Champaign, IL: Human Kinetics.
Witt, P., & Ellis, G. (1985). Development of a short form to assess
perceived freedom in leisure. Journal of Leisure Research, 17,
225-233.
Woodruff, G., & McGonigel, M.J. (1988). Early intervention team
approaches: The transdisciplinary model. In J.B. Jordan, J.J.
Gallagher, P.L. Hutinger, & M.B. Karnes (Eds.), Early childhood
special education: Birth to three (pp. 163-182). Reston, VA:
Council for Exceptional Children.
World Health Organization. See WHO.
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mance, impairment, and the functional classification system.
Adapted Physical Activity Quarterly, 16, 251-270.
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Champaign, IL: Human Kinetics.
YMCA. (1999b). Teaching swimming fundamentals. Champaign,
IL: Human Kinetics.
YMCA. (1999c). The parent/child and preschool aquatic program
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YMCA of the USA and the Arthritis Foundation. (1985). Arthritis
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Young Men’s Christian Association. See YMCA.
This page intentionally left blank.
 Index

A ambulation, assisting 159-160, 160f

American Alliance for Health, Physical Education, Recreation
AAAD. See American Athletic Association of the Deaf and Dance (AAHPERD) 5-7
AAHPERD. See American Alliance for Health, Physical certification by 53
Education, Recreation and Dance on high school aquatics 262
AAPAR. See American Association for Physical Activity and professional development levels in 256
Recreation American Association for Physical Activity and Recreation
ABA. See applied behavior analysis (AAPAR) 7
Accessible Swimming Pools and Spas: A Summary of Adapted Aquatics Assistant training 56
Accessibility Guidelines for Recreation Facilities (U.S. Adapted Aquatics Instructor course 163
Access Board) 15, 111 certification by 53
Achievement-Based Curriculum Development in Physical training programs 104
Education (Wessel, Kelly) 63 American Athletic Association of the Deaf (AAAD) 263
active learning time (ALT) 171-173 American Occupational Therapy Association 22
activities of daily living (ADL) 185 American Physical Therapy Aquatic Therapy Section 22
ADA. See Americans with Disabilities Act American Red Cross (ARC) 5-6, 58, 88, 234
ADA Accessibility Guidelines (ADAAG) 14-15, 108 progressive swim model of 25, 74, 173
“ADA Compliance for Pools and Wet Areas” (Osinski) 109 training programs 104
adapted aquatics 3-4, 5f, 17-18, 18f, 56, 163, 172 Water Safety training 56, 256
advocates 57-58 American Sign Language (ASL) 202, 202f
attributes of learners in 193-226 American Swimming Coaches Association (ASCA) 273-274
common disabilities in 190-193, 191t Americans with Disabilities Act (ADA) 12-15
community support for 86, 92, 104, 106 assessment 41
evolution of 4-10 facilities influenced by 108-109
in-service programs on 54 inclusion meeting spirit of 52
journals publishing articles related to 54-55 reasonable accommodations mandated by 68
models for 22-37 requirements 110-125
reasons for 19-20 antecedents 185, 187
segregation of 19 anxiety 166
specialists 32, 67-68, 82 applied behavior analysis (ABA) 182-183, 187
adapted aquatics programs 22, 67, 94, 254 AquaJogger 123f
age-appropriate 63-66 Aqua-Percept 28
development/evaluation 96-97, 98f- 99f aquatic activities
environments 249-253, 260 cognitive/social prerequisites 59
frequency of sessions 235 enrichment 16-17
nationally sponsored 255, 258-260 recreational 276-279, 280
for profit v. not-for-profit 90-92 rehabilitation promoted by 19
recreation model 30 aquatic chair 119
rehabilitation hospitals conducting 251 aquatic exercise 8, 18, 231
residency facilitating 251 benefits of 15-17, 20
safety measures in 150-155, 152t cognitive/intellectual benefits of 17
selection of 247-260, 248f modifications to 10-11, 11f
successful 86, 106, 164 physical benefits 16-17
ADL. See activities of daily living social/emotional benefits 17
administrators 57-58, 99f, 105f, 111, 270-271 Aquatic Exercise Association (AEA) 8, 22, 259
AEA. See Aquatic Exercise Association aquatic exercise instructor (AEI) 231-235
AEI. See aquatic exercise instructor aquatics
AFYAP. See Arthritis Foundation/YMCA Aquatics Program administrators 57-58, 111
age groups 40, 56, 63-66, 66 applications of 17-19
aides 133 assessment 68-77
alignment 241, 275 general v. inclusive 61, 61f
ALT. See active learning time IDEA definition of 28

345
346 Index

aquatics, continued anxiety 166

integration 46f assessment 187
as lifelong endeavor 279 disorders 48, 192
participation 262-263 modification 182-186
for physical improvement 22 objectives in 75
reasonable accommodations included in 13-14 positive reinforcement and 195
skills varying in 132 blindness 163, 192, 227, 268
specialist 34 in swimmers 175f
aquatics instructor(s) 47, 53, 100f, 130, 170-171. See also total v. legal 224
instructors blood pressure 233
behavioral changes implemented by 183 boating 278-279
certified 99f body
curriculum-based programs taught by 48 alignment 241
distinguishing abilities of 59 awareness 211
goals and 101f mechanics 133-134
participant and 69, 130-133, 160 systems 165
priority list analysis by 79 Borg scales 237
requirements for 164 bowel management 150
supervision of 102 breath 205, 215
supplies used by 124 holding 221
aquatic therapy 8, 18, 70, 73f, 232 pattern 219
Aquatic Therapy and Rehabilitation Institute (ATRI) 8, 22, 259 rhythmic 206, 206f
ARC. See American Red Cross brittle bones 197
architectural barriers 10, 109, 110, 125 buoyancy 155-157, 241f
arthritis 7-8, 20, 192, 200-202 bursitis 243
Arthritis Foundation 5, 7-8
Arthritis Foundation/YMCA Aquatics Program (AFYAP) 7-8, 7f, C
18, 258 Canadian Red Cross 47
ASCA. See American Swimming Coaches Association cardiorespiratory endurance 230, 235-238, 244
Ashworth, S. 61 cardiovascular control 222
ASL. See American Sign Language cardiovascular disorder 198-199
Asperger’s syndrome 39, 195-196, 208-209, 221-222 caregivers 63, 83
assessment 26, 61, 98f, 101f briefing 158
ADA/IDEA 41 consent forms for 95, 232-233
adapted aquatics specialist conducting 67 consulting 197, 207, 208, 213
behavioral 187 instructions from 219-220
educational model of 72-75 waiting areas for 97
for endurance 72 Carter, M.J. 75
inclusion program, of participants 51 categorical approach 23
medical-therapeutic model of 70-71 CEC. See Council for Exceptional Children
needs 26 Centers for Disease Control and Prevention 117
phenotypic 35 cerebral palsy 192, 276
planning for 68-70 athletes with 268
recreational model of 75-76 attributes associated with 200-202, 204-207, 210-211, 217-
skills included in 69f 218, 222-223
therapeutic recreation aquatic 76f case of 229-230
transdisciplinary model of aquatic 77 certification 99f
Assessment of Swimming in Physical Education (Grosse) 72 AEI 235
Association for Persons with Severe Handicaps (TASH) 41 coach 273-274
asthma 192, 219-220 CPR/ARC 8
ATBCB. See U.S. Architectural and Transportation Barriers instructor 17, 52-53
Compliance Board TR specialist 24-25, 29
athletes 262, 264-279, 280 YMCA 7
atlantoaxial instability 194, 194f Certified Pool Operators 116
ATRI. See Aquatic Therapy and Rehabilitation Institute certified TR specialist (CTRS) 24-25, 29
atrophy 214-216 CEUs. See continuing education units
attention 167, 185, 194-196 children 41, 58, 63-66, 63f, 124f
auditory perception disorder 195-196 chondromalacia 243
autism 67, 192, 195-196, 208-213 circulatory disorder 199-200
autonomic dysreflexia 196 CLAs. See community living arrangements
classification 269-272, 280
B coaches 262, 272-276, 280
balance 78f cognition 167, 171, 186
balance disorder 196 collaboration 37, 83
Baruch, Simon 5 with caregivers 207
bathing 149, 149f characteristics 33f
behavior(s) 57, 164, 167-168 interpersonal 32
 Index 347

command style 169 disabilities, individuals with 14, 132. See also inclusion; swimmers
communication 36-37, 101f accessible programs for 66, 111
adapted aquatics programs relying on 91-92 accommodating 20, 68, 83
barriers 132-133, 161 active participation of 176
effective 106, 219, 225 aquatic environment influencing 155
external 91 attitudes toward 4, 230
skills 130-133 children as 63f
verbal/nonverbal 59 competitive swimming for 254-255, 262-269, 262f
community diverse needs of 186, 248, 254, 259
attitudes towards individuals with disabilities 4, 230 fear in 166, 166f
centers 85 goals set by 243, 274
changes in 97 leisure time use of 17
noninvolvement of 31 modifying activities for 57
pool 142 participating with individuals without disabilities 124-125
programs 249-250, 260 placement sought by 41
recreation options 22 reasonable accommodations for 40
support for adapted aquatics 86, 92, 104, 106 recreational aquatic activities and 276-279
swimming 129 recreation options for 31-32, 31f
community living arrangements (CLAs) 251 respect for 132
competition 195, 262, 269-272 safe environment for 47
competitive swimming 254-255, 262-269, 262f self-image of 15-16, 100f, 209, 253
constituents 91-92 skill-level varying in 46
consumer 101f, 111 supporting 130, 171
continuing education units (CEUs) 53 vital capacity of lungs in 16
continuum ladder 42f disability(ies) 23. See also learning
continuums 41-48, 44f, 46f attributes of particular 193-226
contractures 200-202, 227 definitions of common 190-193, 191t
multiple congenital 209 developmental 64
preventing further 210 differences 189-190
wrist 165f, 200f fitness relating to 232-235
Convalescent Swimming Program. See Swimming for the Handi- intellectual 158
capped physical 170
convergent discovery style 170 sports organizations 265-269, 266f, 280
Council for Exceptional Children (CEC) 41 types of 165, 165f
Council for National Cooperation in Aquatics 58 USA-S rules defining 263-264
credentials 17, 20, 52-53, 102 disability-specific treatment 23
Cryptosporidium 116 Disabled Sports USA 266-267
CTRS. See certified TR specialist discrimination 48
cues divergent discovery style 170-171
appropriate 186 D.K. Douglas Company 124
key words for 226 Dolan, M.A. 75
selecting 176 Down syndrome 13, 189-190, 192, 194f, 198-199, 211-213
tactile 224, 224f downthrust 155
teaching, for sport skills 177t-178t Dulcy, F.H. 33
verbal v. nonverbal 131, 184, 211-212, 213f Dummer, Gail 13
cultural values 168, 168f Dunn, J. 184
customers 91-92, 95 Dunn, K. 122, 184
Dwarf Athletic Association of America (DAAA) 265, 267
D
DAAA. See Dwarf Athletic Association of America E
Danmar Products, Inc. 122 educational model 22, 26-29, 36, 72-75
Data-Based Gymnasium (DBG) 184-185 elitism 271
deafblindness 203-204, 204f emergency plans 150-151, 199-200
Deaflympics 9-10 enrichment programs 254
deafness 192, 202-203, 202f, 266 entry, sloped 114f
Dedrick, Dallas 6 equipment 105f, 125, 244
design accessibility 114
elements of program 96-97, 106 adapted 109, 243, 262
instructional 169-172 boating 279
Designing Instructional Swim Programs for Individuals with brightly colored 225-226
Disabilities (Carter, Dolan, & LeConey) 75 children’s 124f
diabetes 192, 199-200, 224-225 comfort with 132
directions 195 entrance/exit 117-120
clarity in 175-176 exercise 230
concise 224 motivational 123-124
problems understanding 227 on pool deck 113
safety 212 propulsion/fitness 123
348 Index

equipment, continued program v. participant 96t

quality of 101f recreation model 30
risk relating to 95 reinforcing 232
safety 120-121 self-initiated 171
scuba diving/snorkeling 278 setting 67, 80-81, 243, 274
storage of 124 specific attributes/conditions and 194-226
support 121-122 in strategic plan 89f, 90
transfer 108, 133 transdisciplinary model 35-36
waterskiing 276 “Good Therapy” (Koch) 109
exercise(s) 23. See also aquatic exercise gravity 155-156, 222, 238-239
duration of 238 Grosse, Susan J. 72, 111
equipment 230 group
intensity 235-236, 244 bonding 167
monitoring 231 IAPP integrating with lesson in 173
as rehabilitation 231-233 instruction v. one-on-one 81-82
ROM 239-240 makeup/size 57-59
size 42f, 52
F guided discovery style 170
face mask 205, 205f, 215
facility(ies) 82f, 87, 104, 105f, 124-125 H
accessible 14, 97, 101f, 108-111, 110f, 114 Halliwick-Method Skill Progression Chart 72
acquisition 94 Handicapped Swimming: A Syllabus for the Aquatic Council’s
adapted aquatics 86 Courses Teacher and Master Teacher of Handicapped
general rules of 151 Swimming (AAHPERD) 7
of Mary Campbell Center 252, 252f hard of hearing 192, 202-203
modifications 14, 95 head control difficulty 204-205, 205f-206f
family changing rooms 130, 148, 148f heart rate 198, 236, 244
fear 166, 166f, 238f heart rate reserve (HRR) 236
federal legislation 4 Hicks, L. 166
on accessibility 108 Hinsdale, Guy 5
aquatics participation influenced by 262-263 hospitals 251
empowering individuals with disabilities 276 HRR. See heart rate reserve
for individuals with disabilities 10-15, 22 human resources 55, 99-106, 102f
on segregation 19 hydraulic pool floors 115, 116f
feedback 176-179, 185-186, 195 hydrodynamics 130, 155-157, 160-161
fibromyalgia 242 hydrotherapy 5, 16, 20
financial development 92-94, 102, 106 hygiene. See bathing
fitness 107, 123, 171 hyperactivity 207-208, 207f
disabilities relating to 232-235 hyperreflexia. See autonomic dysreflexia
health-related physical 231-240
mobility relating to 204 I
routine 200 IAPP. See Individualized Aquatics Program Plan
status 232 ICATRIC. See International Council for Aquatic Therapy and
training 230, 243-244 Rehabilitation Industry Certification
flexibility 238-240 IDEA. See Individuals with Disabilities Education Act
flotation 27f, 156, 156f, 204 IEP. See Individualized Education Program
flotation devices 55f, 108, 121, 121f, 125, 125f, 233, 276 IFC. See International Classification of Functioning, Disability,
frailty 242 and Health
Fredericks, B. 184 IFSP. See Individualized Education Program
frequency 235, 274-275 immune systems 116, 125
functional analysis 183 impatience 186
functional classification 269-271, 280 inclusion 31, 32, 35, 40, 42f, 59f, 239f
fundraising. See financial development activities to facilitate 61-66
benefits of 52
G as best placement 48
games 62-66 environmental prerequisites for 50, 66
goals 82-83, 173, 280 general aquatics v. 61, 61f
annual 78-79 LRE v. 37, 42-43
changing 97 prerequisites for 47-48, 49f, 50-51, 66
curriculum 96 reasonable accommodation and 13-14
educational model 27-28 style of teaching 170
IEP 47 inclusion groups
inclusion program 51 additional adult help required in 52f, 55
instructors providing 101f developing/maintaining successful 52-56
medical-therapeutic model 23-24 group dynamics in 56-59
motivation 82f makeup/size 57-59
participant 96t, 230 participation in 176
prioritizing 79f supports for 54-56
 Index 349

task preparation in 59-61 Kelly, L.E. 63

independence 170, 203, 212, 212f, 279 kinesiotherapists 24, 71-72, 231-232
Individualized Aquatics Program Plan (IAPP) 68, 101f kinesthetic system disorder 210-211
behavioral objectives for 75 knee surgery 242-243
developing 77-81, 83 knowledge of performance (KP) 176, 187
group lesson and 173 knowledge of results (KR) 176, 187
implementing 81-83 Koch, Mike 109
Individualized Education Program (IEP) 11, 43 KP. See knowledge of performance
aquatics in 29 KR. See knowledge of results
developing 77-81, 83 kyphosis 192, 216, 219-220
goals 47
implementing 81-83 L
team 67 labeling 190, 227
Individualized Family Service Plan (IFSP) 11 Lantz, P.J. 13
individualized plans 27, 67-83, 98f, 174f, 252, 259 language disorders. See communication
Individualized Transition Plan (ITP) 11 LDA. See Learning Disabilities Association
Individuals with Disabilities Education Act (IDEA) 10-11, 52, 263 learner-designed individual program style 171
aquatics defined by 28 learner-initiated style 171
assessment 41 learning 186, 187
mandates of 25-26 disability 192, 194-195, 210-213, 217-218, 221-223, 225-
support services mandated by 40 226
in-service programs 54 environmental structure of 185-186
instruction 98f, 105f, 172f modality, preferred 168
from caregivers 219-220 physiological factors influencing 164-166, 165f
design of 169-172 psychological factors influencing 166-168
effective 174, 187 requirements for successful 164
modifying 175 style 186
one-on-one v. group 81-82 Learning Disabilities Association (LDA) 41
strategies of 168-186 learning style matching 168
time estimated calculation of 80t least-restrictive environment (LRE) 26, 31, 40
instructors 58. See also aquatics instructor(s) inclusion v. 37, 42-43
attributes of 19 LeConey, S.P. 75
credentials 17, 20, 52-53 leisure 17, 32
educational model training for 29 Leisure Opportunities for Individuals with Disabilities: Legal
importance of educated 50-51 Issues (Grosse, Thompson) 111
preparation for 39-40 lesson 172-173
integrated leisure 32 content 27
integration 280 modifying 215
aquatics 46f plan 82-83, 186
sport 265 “Leveling the Playing Field or Leveling the Players? Section 504,
intellectual disability 190, 217-218, 221-222, 225-226, 272 the Americans with Disabilities Act, and Interscholastic
intensity 235-237, 237f, 244, 274-275 Sports” (Sullivan, Lantz, & Zirkel) 13
interaction difficulty 208-209 Life Jacket-Adapted Inc. 122
International Classification of Functioning, Disability, and lifts 10, 10f, 108, 117, 161
Health (IFC) 230 hydraulic 210
International Council for Aquatic Therapy and Rehabilitation hydropowered 141, 141f-142f
Industry Certification (ICATRIC) 259 movable v. permanent 118-119, 118f
International Paralympic Committee (IPC) 268, 271 two-person standard 134-136, 135f-136f
International Sports Federation for Persons with Mental two-person through-arm 137-138, 137f
Handicap (ISFPMH) 271 LINK (the leisure integration network) 46
intervention 183-184 locker room 107, 110f, 111-112
IPC. See International Paralympic Committee care in 132, 147-155, 148f-149f
IPC Swimming Classifications Manual 269 cleanliness of 219
IPC Swimming Handbook 268 safety in 130
ISFPMH. See International Sports Federation for Persons with seizure in 155
Mental Handicap lordosis 193, 216
Lowman, Charles 5
J LRE. See least-restrictive environment
Jeff Ellis and Associates 256-257 LRE model 45f, 47
Jewish Community Center 249
job analysis 102 M
joint dysfunction 209-210 Macedonia Department of Recreation and Parks 148
Journal of Special Education 13 Marco Polo 62, 196
Mary Campbell Center 252, 252f
K mats 120, 121f, 143f, 215, 223, 223f
Karvonen 236 maximum heart rate (MHR) 236, 244
Kellogg, John 5 medical classification 269
350 Index

medical hydrology 16 occupational therapy 70, 71f-72f

medical-therapeutic model 4f, 36 Official Special Olympics Summer Sports Rules 267
of aquatic assessment 70-71 Olympic and Amateur Sports Act 263, 280
distinct components of 22-23 oral motor dysfunction 213-214, 214f
goals/objectives 23-24 organizational foundations 86
settings/providers for 24-25 building effective 106
medication 164-166, 186, 219, 233 financial development for 92-94
memory 211-213, 212f not-for-profit 90-91, 249
mental retardation 193. See also intellectual disability for sports 265-269, 266f, 280
MHR. See maximum heart rate strategic planning for 87-90
mission 88-90, 89f, 96, 249 Osborn Aquatic Center 253, 253f
mobility 151, 204 Osinski, Alison 109
mobility difficulties 114-115, 115f overload 239
modifications 13, 175, 280
of activities for individuals with disabilities 57 P
aquatic exercise 10-11, 11f Palaestra 13, 54
behavior 182-186 Paralympics 9, 268, 269, 272
exercise 244 Paralympic sport organizations (PSOs) 9
facility 14, 95 paralysis 200-202, 214-216
of game activities 62 paraplegia 261
of lessons 215 parents. See caregivers
of rules 267 paresis 200-202, 214-216
in scuba diving/snorkeling 277 Parks & Recreation 45-46
to swim strokes 164, 179-182, 179t-181t, 187, 214, 217 participant(s) 51, 176, 231
task 100f assisting 132, 149
of water activities 262 behavior 167-168
Moran, J. 166 care/safety 130-132, 147-155, 254
Morehouse, J. 184 common attributes of adapted aquatics 193-226
Mosston, M. 61 cultural aspects of 168, 168f
motivation 164, 170 goals of 96t, 230
equipment for improving 123-124 holding 158-159, 159f
fitness 234 inclusion 47-48, 51
goal 82f interacting with instructor 69, 130-133, 160
for learning 167 interview 69
MS. See multiple sclerosis KR/KP information obtained by 179
MSD. See multisensory deprived monitoring progress of 174-175
multidisciplinary team (M-team) 33 needs of 235, 254, 259
multiple congenital contractures 209 positioning 160
multiple sclerosis (MS) 8, 193, 200-202, 204-207, 214-216, 222, removal of 185
224-226 skill-levels varying in 46, 132, 170-171
multisensory deprived (MSD) 203 touching 157-158, 221
muscle tone transferring independently 133
development of 217, 217f peer tutor 82
high 206-207 performance 269
low/high 213 criteria 170
present level of 77-78, 173
N recognition of excellent 106
natatorium 163 personal flotation device (PFD) 55f, 276
National Council on Disability (NCD) 41 personnel 99f. See also staff
National Disability Sports Alliance 268, 269 PFD. See personal flotation device
National Multiple Sclerosis Society (NMSS) 5, 8, 18, 104, 259 “PFDs for the Handicapped: A Question of Responsibility”
National Multiple Sclerosis Society: Aquatic Exercise Program 200 (Dunn, K.) 121-122
NCD. See National Council on Disability phenotypic assessment 35
NMSS. See National Multiple Sclerosis Society philosophy 22, 30-31, 37, 264
noninvolvement 31 physical education
adapted 19, 28f, 55-56
O land-based 3, 253
obesity 193, 242 legal definition of 11, 20, 280
objectives 83 Physical Education for the Severely Handicapped: A Systematic
behavioral 75 Approach to Data-Based Gymnasium (Dunn, J.,
education model 27-28 Morehouse, Fredericks) 184
medical-therapeutic model 23-24 physical therapists 24, 72, 218
short-term 78-79 Physician’s Desk Reference 198, 208, 220
in strategic plan 89f, 90 placement 40, 98f
transdisciplinary 35-36 appropriate 66, 70, 81
writing 80-81 inclusion as best 48
occupational therapists 24, 70 origin of concept 41
suggesting 67
 Index 351

plantar fasciitis 243 “Reasonable Accommodations for Swimmers with Disabilities”

pool (Dummer) 13
access 124-125, 229 reciprocal style 169
accessibility guidelines for 15 recreation model 22, 29
community 142 of aquatic assessment 75-76
difficulty in 159 important issues regarding 30-31
drinking water of 213-214 program-types for 30
entries/exits 110f, 114, 114f, 214 recruitment 103-104
independence in 107-108 rehabilitation 5, 129
land exercises adapted to 70, 72f aquatic 230, 240-243
movable floors for 115, 116f aquatic recreational activities to promote 19
seizures in 153-154, 154f exercise as 231-232
size 97, 114-115 hospitals 251
space, soliciting 94 maximizing potential in 17
YMCA 109 Rehabilitation Act of 1973 10, 263
pool deck 110f, 112-114 relationships 32, 44, 160
seizures on 155 relaxation 17, 208
transfer to/from wheelchair 134-147, 135f-137f, 139f-147f rescue tube 206f
population, specific 105f residential programs 251
POR. See problem-oriented report resistance 157, 241f
positive reinforcement 195, 203, 208 respect 131-132, 160
posture 218f, 231 respiratory disorder 219-220
alignment v. 241 respiratory function 215, 227
problems with 216 revenue generation 92-93
proper 222 Reynolds, Grace Demmery 6-7
A Practical Guide for Teaching the Mentally Retarded to Swim risk management 106
(AAHPERD) 7 in boating 278-279
practice style 169 plan 116-117
praise. See positive reinforcement programs 94-95
pregnancy 242 Rocky Run YMCA 250, 250f
prerequisites role release 33, 37
for aquatic activities 59 ROM. See range of motion
inclusion 47-48, 49f, 50-51, 66 rule(s)
staff 102 constancy in 208
Priest, Louise 6 general facility 151
problem-oriented report (POR) 23 modifications 267
production style. See divergent discovery style safety 40
professional development sponsorships 259 transfer 133
program evaluation form 98f USA-S 263-264, 273-275
programs. See adapted aquatics programs
progressive swim model 25, 74, 173 S
prone hold 158-159, 159f SAFE. See Schools for Everyone
proprioceptive disorder. See kinesthetic system disorder safety 13, 27f, 105f, 161, 212
props 63f, 241f adapted aquatics 150-155, 152t
prostheses 123 additional help to ensure 55
PSOs. See Paralympic sport organizations audits 95
pulse, monitoring 233, 233f in boating 278-279
buddy system for 221
Q certifications 274
qualified individual 12 emotional/physical 47
questions, asking 131 equipment/supplies 120-121
flotation devices contributing to 121
R issues, for particular attributes/conditions 194-226
raft ball 59, 59f, 60 participant 130, 147-155, 254
ramps 119 rules 40
range of motion (ROM) 197, 200-202, 206, 209, 217 in scuba diving/snorkeling 277-278
assisting with exercises for 234 safety, continued
exercises 239-240 social 262
improving 238, 254 transdisciplinary model issues of 37
range of motion dysfunction. See contractures in transferring 130
rapport. See trust water 22, 29, 43, 72, 164, 204
readily achievable 14, 111 in waterskiing 276
reasonable accommodation 68, 108, 109 school programs 251-253, 253f, 262
aquatics programs inclusion of 13-14 Schools for Everyone (SAFE) 41
definition of 163 scoliosis 193, 216, 219-220
exceptions to 12-13 scuba diving 277-278
for individuals with disabilities 40 sedentary life 232-233
segregation 19, 31-32, 46f, 259, 265, 280
352 Index

seizure 161, 232-233 starts 275

disorders 220-221 storage 124
first aid for 153t strategic planning 87-90, 87f, 89f, 106, 171-172
in locker room/pool deck 155 strength 240, 241f
management 152-153 stress fracture 243
mats used in 120 Sullivan, K.A. 13
in pool 153-154, 154f supine hold 158-159, 159f
self-check style 170 supplies 125
self-image 15-16, 100f, 209, 253 entrance/exit 117-120
self-monitoring 186 on pool deck 113
self-teaching style 171 propulsion/fitness 123
Sherrill, Claudine 19 safety 120-121
shin splints 243 storage of 124
shower areas 130, 147-152, 149f support 121-122
skills 46, 100f Swim America 258-259
ADL 185 swimmers
aquatics developing life 279 blind 175f
assessing 69f deafblind 203-204, 204f
communication 130-133 with disabilities 42f, 56, 63-66, 122, 125, 179t-181t, 263-276
demonstrating 74f efficient 164
entry/exit 197 exercise program for 216-217
factors influencing 83 independent 203, 212, 212f, 229
fear influencing 166, 166f positioning of 218f
functional 269 safety of 254
generalization of 212 swimming 68
logical progression of 186 abilities 232
practicing 164, 176 benefits of 16-17, 20
sequence of learning 78-79 blood pressured monitored during/after 237
sport 177t-178t community 129
swimming 43, 46f, 186 competitive 254-255, 262-269, 262f
varying levels of 46, 132, 170-171 enjoyment of 17
snorkel 205, 205f for fitness 107
snorkeling. See scuba diving functional classification system and 270-271
socialization 129, 167-168, 170, 186. See also interaction difficulty head-position in 160
solicitation, direct 93 through hoop 226f
spas 4-5, 15 intensity of 198
special education teachers 29 learning 163
Special Olympics 5, 8-9, 104, 263, 267-268 mastery of activities in 61
classification 271-272 modifications in 280
coaches 274 negative preconceived ideas about 167
mission of 88 recreational 74, 262
program components of 257 skills 43, 46f, 186
specific gravity 155-156 speed 210
spinal cord injury 193, 196, 200-202, 214-216, 222, 236-237 wheelchair 268-269
sport(s) Swimming for the Handicapped 6
classification in 269-272 A Swimming Program for the Handicapped (Reynolds) 6
integrated v. segregated 265 swim strokes 60, 68, 217f
medicine 72 adapting 19, 19f, 174f, 205
organization 265-269, 266f, 280 developing proper 254
participation 262 learning 72
training 274-276 mechanics of 238-239, 275-276
Sprint Aquatics 120, 122 modification of 164, 179-182, 179t-181t, 187, 214, 217
Sprint Flow Through Mat 120, 125f symmetrical 78f
staff 87, 149f timing of 171
appraisal 104-105 “Systematic Desensitization of Aquaphobic Persons” (Hicks) 166
awareness of consumer needs 111
development 103, 103f, 106 T
emergency-preparation for 199-200
of Mary Campbell Center 252 tactile system 203-204, 204f, 221f, 224, 224f
of Osborn Aquatic Center 253 talk test 237
paid 103f tap stick 163
positions 105f TASH. See Association for Persons with Severe Handicaps
prerequisites/credentials 102 task analysis 75
recognition/retention 106 teaching styles 169-171, 187. See also aquatics instructor
recruitment 103-104 tactile 203-204, 204f, 221f
therapeutic support 208 teaching tips 190, 194-226
training 95, 104 temperature regulation disorder 222
stairs 115f, 119, 210 tendonitis 243
 Index 353

tether 238f, 276 visual perception disorder 225-226, 227

theory, learning 26 vital lung capacity 197
therapeutic programs 251 volunteer 104, 105f, 257
therapeutic recreation (TR) 24, 36
foundational philosophy of 30 W
specialist 75
Therapeutic Recreation Systems (TRS) 123 warm up 238
therapeutic support staff 208 water
therapeutic water exercises 18-19, 20 activities 262
therapy hands 158, 161 appeal of 15-16, 20
Thompson, D. 111 biological effects of 16
time 235, 238, 274-275 buoyancy of 129
toilet training 150 chair 239f
toys 123-124 depth 156-157, 219
TR. See therapeutic recreation drinking pool 213-214
transdisciplinary model 22, 32 fear of 232
of aquatic assessment 77f noodles 55f, 121
distinct components of 33-35 observation in 270
goals/objectives of 35-36 orientation 279
important issues regarding 36-37 play 58
settings/providers for 36 pressure 198
success of 35f prevention from swallowing 55
transfer 161. See also wheelchair prostheses designed for 123
backward movement in 147f resistance provided by 157
dependent 134-142 safety 22, 29, 43, 72, 164, 204
equipment 108, 133 temperature/quality 97, 112, 115-117, 125, 157, 199
forward pivot 145, 145f as therapeutic tool 4
general rules in 133 warm 17, 207, 216, 240
hydropowered lift 141, 141f-142f Water Safety Instructor (WSI) 6, 256
independent 140, 142-147, 142f-147f Water Safety Instructor’s Manual (ARC) 256
safe/successful 130 waterskiing 276
sliding board 140, 140f-141f wave drag 157
spastic movements during 207 webbed gloves 241f
standing pivot 138, 139f Wessel, J. 63
systems 120 WetVest 55f, 234-235, 234f
wall 113, 113f Wet Wrap 124
Transfer Tier 14, 120f wheelchair 107, 112
TRS. See Therapeutic Recreation Systems swimming 268-269
trust transferring to pool from 113-114, 113f
developing 132, 160, 197 transfer to/from pool deck 134-147, 135f-137f, 139f-147f
touch establishing 203 Wheelchair Sports, USA 268-269
touching related to 158 WHO. See World Health Organization
turns 275 Wilson, Kit 7
type, activity 235, 238, 274-275 workshops 104
World Health Organization (WHO) 230, 244
wraparound staff. See therapeutic support staff
U wrist contractures 165f, 200f
understanding difficulty 211-213, 213f, 227 WSI. See Water Safety Instructor
unidisciplinary model 33, 34f, 37
United Cerebral Palsy 88, 104 Y
United States Aquatic Association of the Deaf (USAAD) 9-10
United States Association of Blind Athletes (USABA) 268 YMCA. See Young Men’s Christian Association
United States Water Fitness Association (USWFA) 8, 22 Young Men’s Christian Association (YMCA) 5, 8, 22
upthrust 155 adapted aquatics programs in 258
urinary management 150 certified instructors 53
USAAD. See United States Aquatic Association of the Deaf instructional/recreational aquatics within 6-7
USABA. See United States Association of Blind Athletes mission of 88
U.S. Access Board 11, 15 as not-for-profit organization 249
USA Deaf Sports Federation 266 pool 109
U.S. Architectural and Transportation Barriers Compliance Board progressive swim model of 25
(ATBCB) 108 Rocky Run 250, 250f
USA-S. See USA Swimming training programs 104
USA Swimming 263-264, 273-275, 280 Young Women’s Christian Association (YWCA) 8, 249
USWFA. See United States Water Fitness Association YWCA. See Young Women’s Christian Association

Z
V Zirkel, , P.A. 13
visual impairment 223-225, 224f
 About the Authors

Monica Lepore, EdD, is a professor at West Chester University

of Pennsylvania in West Chester. A Master Teacher of Adapted
Aquatics, Dr. Lepore has been an American Red Cross water
safety instructor for more than 25 years. She has a degree in lead-
ership in adapted physical education and was a recipient of the
International Swimming Hall of Fame Adapted Aquatics Award
in 2001. In 2006 she was named AAHPERD/AAPAR Adapted
Physical Education Professional of the Year, and she has been
on the Top 100 Aquatics Professionals list twice. She acted as
chair for AAHPERD/AAPAR adapted aquatics from 2000 to 2005
and received a Meritorious Award from the Aquatic Council of
AAHPERD/AAPAR in 2005. In her leisure time, Dr. Lepore enjoys
swimming, biking, and hiking.

G. William Gayle, PhD, CAPE, is a professor and coordinator of

adapted physical education at Wright State University in Dayton,
Ohio. A Master Teacher of Adapted Aquatics, Dr. Gayle has been
an American Red Cross water safety instructor for over 20 years.
He holds degrees from Virginia Tech and University of Wisconsin
at LaCrosse and a doctorate in adapted physical education and
psychology of mental retardation and developmental disabilities
from Ohio State University. In 1988 he was inducted into the
Ohio Wheelchair Sports Hall of Fame. He served on the AAH-
PERD/AAPAR adapted aquatics committee from 2000 to 2005. In
2006 he was inducted into the National Wheelchair Basketball
Association Intercollegiate Division Hall of Fame and selected
as Teacher of the Year in the College of Education and Human
Services at Wright State University. He has provided adapted
aquatics programs for university students and surrounding school
districts for several decades. In his leisure time, he enjoys golfing,
swimming, and traveling internationally.

354
 About the Authors 355

Shawn F. Stevens, EdD, is executive director of Edgemoor Com-

munity Center in Wilmington, Delaware. Dr. Stevens has been an
American Red Cross instructor trainer for water safety, lifeguard-
ing, first aid, CPR, and AED for 25 years, and he was an adapted
aquatics instructor trainer for 18 years. Overall, he has provided
leadership in conducting aquatics programs for 30 years, and
he assisted with the development of the ADA Accommodation
Resource Guide for the American Red Cross. In his spare time,
he serves as a volunteer instructor trainer and leadership volun-
teer for the American Red Cross, and he also enjoys golfing and
swimming.
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