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Comparison Of Hydrotherapy Treatment In A Pool With And Without Sensory Adaptation, For Toddlers With Developmental Disabilities

Daphne Asher - Hydrotherapist, Beit Issie Shapiro
Dr. Dana Roth - Head of the Research and Evaluation Dept., Beit Issie Shapiro
Dr. Michele Shapiro - Former head of the Snoezelen Field, Beit Issie Shapiro
Merav Hadar-Frommer - Senior Physiotherapist and Hydrotherapist, Beit Issie Shapiro


Asher D., Shapiro M., Roth D., and Hadar-Frommer M. (2010). Comparison of hydrotherapy treatment in a pool with and without sensory adaptation, for toddlers with developmental disabilities, Israeli Journal of Occupational Therapy, 19(1), 7-27.


About the research  


Sensory regulation is defined as a person’s ability to regulate and organize the quantity, strength, and type of response to sensory stimulation, in a graduated and appropriate manner. This ability enables a person to achieve and maintain an optional functional range, and adjust to changes in everyday life.

The process of sensory regulation takes place on a regular basis in the central nervous system, and develops in childhood through interaction between the child and the environment. When sensory regulation is deficient, the child’s response to stimuli is liable to be abnormal, and not appropriate to the particular stimulus. The deficiency may be manifested in all the sensory systems, such as: touch, smell, and movement. In certain children the response may be oversensitivity, while others may display under-sensitivity.

In recent years a connection has been found between sensory regulation and the performance of motor tasks, learning ability, attention, and behavior.

One of the various treatment approaches that has developed from an understanding of the influence of the physical environment on the senses, on a person’s behavior, and on sensory regulation is the Snoezelen approach, developed by Ad Verheul. He mentions two characteristics that are the basis for the Snoezelen approach: an adapted environment, and the enabling therapist approach.

  • The therapeutic environment of the Snoezelen room enables controlled multisensory stimulation, arousing or calming, adapted to the needs of each patient in terms of the nature, quantity, organization, and strength of the stimuli.
  • The therapist does not direct the patient to any particular, predesigned path, and leaves control of the process in the hands of the patient.

Hydrotherapy is a treatment method that also relates to multisensory stimulation. Being in warm water provides multisensory stimulus of three systems at the same time: vestibular, proprioceptive-kinesthetic, and tactile. The water produces considerable perceptual stimuli: auditory, visual, and stimulation of the sense of taste. The properties of water also affect the functioning of the physiological system in the body, enabling actions to be performed that are not possible on dry land. Floating releases tension and weight on the joints and muscles. The resistance of the water enables muscles to be strengthened or relaxed.

Hydrotherapy has been found to be an effective intervention for improving mobility functioning in early intervention for infants, as well as producing a certain improvement of motor skills in children with cerebral palsy, muscle diseases, and so on.


Hydro-Zen – combined therapy  

Hydro-Zen combines hydrotherapy, Snoezelen, and Zen.

The therapist builds the intervention in accordance with the interest and responsiveness of the patient, changing the treatment process accordingly. The sensory need of the patient is answered by adapting the visual stimulus (color, strength of lighting), and auditory stimulus (noise-free environment, soothing or stimulating music, above and below the water), and controlling sensory stimuli (turbulence, rate of movement, and water toys). The staff follows the enabling therapist approach.


The research  

The research studied three children with different developmental disabilities.

The research hypothesis was that Hydro-Zen therapy would have added value for different functional fields.



The hypothesis was confirmed in part.

An analysis of the findings of each individual child showed a positive trend in favor of Hydro-Zen in variables such as: head control, arm and leg movements, strength of laughter, and others. The results showed a decrease in the degree of restlessness, the quantity and strength of self-stimulation, and an increase in the number of floating positions. When the level of stimulation is adapted to the needs of the child, he or she will be more relaxed and manifest a sense of calm. The combined treatment has been developed at Beit Issie Shapiro.

The findings reinforce the hypothesis that a combination of hydrotherapy and the Snoezelen approach strengthens the unique properties of each of the approaches, and enables better therapeutic results to be achieved, promoting the quality of life of the patients.


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  • Disabilities:

    Developmental Disability

  • Topics:

    Multi-Sensory Environments

  • Keywords:


  • Audience:

    General public, Professionals

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