A Guide For Swimming Teachers The Centre for Cerebral Palsy
Transcription
A Guide For Swimming Teachers The Centre for Cerebral Palsy
A Guide For Swimming Teachers The Centre for Cerebral Palsy 106 Bradford Street, Coolbinia, Western Australia, 6050 Correspondence: PO Box 61 MOUNT LAWLEY WA 6929 Ph: (08) 9443 0211 Fax: (08) 9444 7299 Website: www.tccpcom.au Email: [email protected] This booklet was prepared by: Kate Sheard, Amelda Preston, Matthew Brain. Updated by Natalie Georgeff and Jessica Morris. © Copyright 1999, 2003. This booklet may be reproduced in whole or part, subject to the inclusion of the source and no commercial usage or sale. Foreword The Western Australian Department of Education and Training conducts an extensive swimming and water safety programme that provides students with the opportunity to learn and develop important life skills in a structured environment. The Department recognises that each student is an individual and that learning experiences should respect these differences and start at the level of the student. The updated version of ‘A Guide for Swimming Teachers’ provides a skills framework, which incorporates the Foundation Levels of the Health and Physical Education Outcomes and Standards Framework and Stages 1 to 3 of the Department’s Swimming and Water Safety Continuum. This information will assist teachers to modify activities and skills to better meet the needs of students with cerebral palsy. I would like to congratulate the Physiotherapists at the Cerebral Palsy Association of Western Australia who were responsible for updating this booklet. Also Janet Boer-Draffin, who wrote the section ‘Hints and Suggestions when Working with Students with Disabilities’, AUSTSWIM WA and the Royal Life Saving Society WA Branch who participated in the initial planning of the document and the Department’s Swimming and Water Safety Section for its review of the final document. I am pleased to endorse ‘A Guide for Swimming Teachers’ and commend it as a valuable tool for any swimming teacher working not only with children with cerebral palsy, but with any child who has a disability. PAUL ALBERT DIRECTOR GENERAL 2 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers Table of Contents Foreword 2 What is Cerebral Palsy? 4 Types of Cerebral Palsy 5 What Part of the Body is Affected? 6 Curriculum Framework and Inclusivity 7 General Principles of Teaching and Assessment 8 Hints and Suggestions when Working with Students with Disabilities 9 Water Safety and Pre-Swimming Skills 11 The Stages of Swimming 13 Foundation Skills - Mild/Moderate Disability 14 Stage 1 - Mild/Moderate Disability 16 Stage 2 - Mild/Moderate Disability 18 Stage 3 - Mild/Moderate Disability 21 Foundation Skills - Severe Disability 24 Stage 1 - Severe Disability 26 Stage 2 - Severe Disability 28 Stage 3 - Severe Disability 29 Equipment Available 32 List of Contacts 33 Acknowledgements 35 References 36 Bibliography 37 © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 3 What is Cerebral Palsy? The brain controls all that we do. Different parts of the brain control the movement of every muscle of the body. In cerebral palsy there is damage to, or lack of development in, one of these areas of the brain. ‘Cerebral’ refers to the brain. ‘Palsy’ can mean weakness or paralysis or lack of muscle control. Cerebral palsy, therefore, is a disorder of muscle control which results from some damage to part of the brain. The term cerebral palsy is used when the problem has occurred to the developing brain either before birth, around birth or early in life. Control of Movement Sensation of Touch Thought Processes Sight Speech Figure 1 4 The Brain © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers Types of Cerebral Palsy There are several different types of cerebral palsy. Spastic Cerebral Palsy This is the most common type of cerebral palsy. Spasticity means stiffness or tightness of muscles. The muscles are stiff because messages to the muscles are relayed incorrectly through the damaged part of the brain. When people without cerebral palsy perform a movement, some groups of muscles become tighter and some groups of muscles relax. In children with spastic cerebral palsy, both groups of muscles may become tighter. This makes the movement difficult. Athetoid Cerebral Palsy Athetosis is the word used for the uncontrolled movements that occur in this type of cerebral palsy. This lack of control is often most noticeable when the child starts to make a movement. In addition, children with athetoid cerebral palsy often have very weak muscles or feel floppy when carried. Ataxic Cerebral Palsy This is the least common type of cerebral palsy. Ataxia is the word used for unsteady shaky movements or tremor. Children with ataxia also have problems with balance. Mixed Types Many children do not have just one type, but a mixture of several of these movement patterns. Definitions of Ability Levels • Mild - Children in this category will be able to participate in swimming lessons with little modification of skills required. • Moderate - Children will swimming lessons and may • Severe - Children will require equipment and assistance to participate in swimming lessons. © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers require some modifications during need concessions to pass levels. 5 What Part of the Body is Affected? This varies greatly from one child to another, depending on the body parts affected. This will alter the shape and density of the body and affect movement in the water. Hemiplegia The leg and arm on one side of the body are affected. Children with hemiplegia will have asymmetrical or uneven movements. Swimming can emphasise movement of the affected side. Diplegia Both legs and both arms are affected but the legs are significantly more affected than the arms. Children with diplegia usually have some clumsiness with their hand movements. Figure 2: The various forms of cerebral palsy and the regions of the brain affected. From Children with Handicaps: A Medical Primer (p. 195) by M.L. Batshaw and Y.M. Perret, 1981, Baltimore: Brookes. Drawing by Elaine Kasmer. Copyright 1981 by Mark L. Batshaw and Yvonne M. Perret. 6 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers Curriculum Framework and Inclusivity Learning experiences should respect and accommodate differences between learners The Curriculum Framework(1) was introduced into all Western Australian education systems and sectors in 1999. The fundamental purpose of the Curriculum Framework is to provide a structure around which schools can build educational programmes that ensure students achieve agreed outcomes. The Department of Education and Training’s Swimming and Water Safety Programme has established appropriate water safety outcomes for all students through the implementation of an integrated teaching, assessment and reporting document - The Swimming and Water Safety Continuum(2). The Curriculum Framework’s Overarching Statement provides general advice about learning, teaching and assessment based on understandings of how students learn best in outcomes-focused education. The Department of Education and Training’s swimming programmes clearly link with these key principles. Inclusivity is providing all groups of students with access to the widest possible and most empowering range of knowledge and skills. It means recognising and accommodating the different starting points and previous experiences of individual students or groups of students, and valuing and including the understandings, knowledge and ways of knowing and being of all groups. It also requires the provision of opportunities for students to critically analyse the social patterns and constructions associated with such concepts as disability, race, class and gender. Instructors should plan lessons that respect and accommodate differences between learners. When planning and implementing learning and teaching activities for students, it is important to acknowledge that each individual is different. Each student needs to be challenged, but the nature of the challenge may vary from student to student. Students with disabilities should be provided with appropriate, alternative avenues for achieving the outcomes. © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 7 General Assessment Principles ASSESSMENT “Assessment practices have a powerful impact on learning and teaching. Assessment information should enable judgements to be made about students’ progress towards the desired outcomes in a way that is fair and contributes to continued learning. Fair assessment is based on criteria which are valid and transparent and applied with consistency and without discrimination.” (2) The Curriculum Framework - (1) states that assessment should be: Valid Educative Explicit Fair Comprehensive “Students should have equal opportunities to demonstrate their achievement of outcomes. Assessment should be sensitive and responsive to differences amongst students, so that they are not inadvertently placed in a better or worse position to demonstrate their achievement.” (2) CONCEDED PASSES There are strict guidelines for conceding a pass in any of the skills in the Continuum. A supervisor may, on sighting appropriate evidence that a swimmer has attempted the same skills on three previous occasions in separate series of Department of Education classes, concede a pass in that skill. In such cases the supervisor must write the following statement on the swimmer’s report: “After three separate attempts in Department of Education classes, and despite additional attention and instruction,…(Name)...has been granted a conceded pass in skill number __.” The Centre Supervisor must countersign this statement and the swimmer should be directed to take the report to their instructor when attending their next series of classes. (2) 8 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers Hints and Suggestions when Working with Students with Disabilities © Janet Boer-Drattin 1. (3) Find out what is achievable for the student and what is not The more information you can gather regarding the abilities of the student in your class, the better prepared you will be for making informed judgements regarding the programming and assessing of these students. Physiotherapists involved with the student, parents, teachers and teacher assistants can be excellent sources to gather this information. 2. Try to keep the student with his/her peers Concentrate on what the student can do and work on this. Teaching should start at the level that the student is currently achieving. Work on the student’s strengths. For example, if it is not possible for the student to swim strokes on his front and back, then ignore the one that is not going to be achieved and strengthen the preferred stroke. 3. If the distance is correct then the style is not the major concern Look at the main goal of the stage/level as well as the distance. The individual technique that a swimmer uses should be allowed if it is effective. The swimmer may have a disability affecting arm rotation or their kick but is still able to swim the distance required. 4. Don’t hold the students back in stages they won’t be able to achieve There are strict guidelines for a Conceded Pass as outlined on Page 8. If a skill is never going to be achieved due to their disability, it is fair and reasonable to skip this particular skill and not hold the student back in this stage. Tick the skills that have been achieved and leave the others blank, stating why they were not achieved. For example, ‘due to physical limitations this skill could not be achieved’. © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 9 5. Remember to treat each person with a disability as an individual and assess in this way ‘Must sees’ are the non-negotiable indicators or standards of performance required to pass the skill. Sometimes a flotation device is needed to assist the student to achieve the desired skill or perform a particular stroke using the most effective way of moving through water. The must see can be ignored in these cases if the primary skill is achieved. 6. Modify the skills to suit the student If the continuum is way out of reach for the student with a disability then use either the Department’s Special Needs Certificate where you can write the successfully completed skills and activities on the form or the Department’s Participation Certificate which has further simplified the basic swimming skills. 7. Be the best swimming teacher you can be Be creative with challenges, use problem solving to assist the student with a disability. It may mean thinking of different flotation devices to use, activities to accommodate the swimmer or a better understanding of the progressions and movement patterns of the student with a disability. 8. The assistance the student needs may not be the ‘flotation device’ alone A smaller class size to assist the student with a disability. Physical assistance from another person can keep your swimming lesson running smoothly and safely. Discuss these issues with the supervisor, teachers or principal of the school for further options. You can also contact the student’s physiotherapist, if they have one. REMEMBER: Look at the students’ abilities and work on their strengths © Janet Boer-Draffin No 2002 10 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers Water Safety and Pre-Swimming Skills ENTRY TO WATER EXIT FROM WATER Entry from sitting on side of pool: Exiting pool over side: T The ‘Humpty Dumpty’ song T Exit pool onto stomach with hands encourages leaning forwards and blowing on entry into the water T Sitting on edge of pool with child’s hands outstretched and leaning forwards to enter pool in upright position on pool side. Lift body and legs together encouraging child to assist. Take arm to rotate and sit on edge of pool T Walking up steps/ramp with/ without rail. Bottom shuffle (backwards) up steps T Hold child close initially. Gradually lower your arms to progress child to falling forwards into water with hands on your shoulders T Use hoist or ramp with wheeled chair T Use of ladder T Walking down steps/ramp with/ without rail T Use of hoist T Use of ladder T Bottom shuffle (forwards) down steps T Use ramp with wheeled chair T Slide in from pool side T Use of hoist © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 11 Water Safety and Pre-Swimming Skills BREATH CONTROL Blowing bubbles at surface on water WATER CONFIDENCE T Splashing games and water on the face T Blow on child’s open hand to help give them the idea T Encourage ‘blowing out’ as the child approaches the water T Practise blowing balls over a distance and ‘flipping eggs’ Exhale with face in water T Eyes open under water with counting fingers, colours, animals. Try goggles T Disengagement: encourage increased independence in complete safety providing minimal support T ‘Ring O Rosie’ or ‘Here We Go Round the Mulberry Bush’ songs encourage disengagement while holding hands T Games sitting astride knee ‘Wheels on the Bus’, ‘Hokey Pokey’, ‘Grand Old Duke of York’, gradually withdrawing support T Practice turning head so ears are in the water T Use of flotation devices - kicking board, noodle T Submerge: “1,2,3 under”. Encourage mouth and lip closure to hold breath or exhale if able. ‘Kangaroo Bobbing’ to chin _ bottom lip _ mouth _ nose _ head submerged 12 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers The Stages of Swimming (Department of Education and Training, Outcomes and Standards Framework for Physical Education) (4) TEACHING TOOLS: This section outlines an approach to teaching children with varying levels of disability and provides an alternative skills framework which incorporates the Foundation Levels of the Health and Physical Education Outcomes and Standards Framework and Stages 1 to 3 of the Swimming and Water Safety Continuum. These skills have been selected as a basis for teaching swimming and water safety to all children and are sequenced for children with mild/moderate disability and severe disability. Key: Bold = primary skill Regular = skill Italics = must see © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 13 FOUNDATION SKILLS Mild/Moderate Disability SKILL 14 LIMITATION IDEAS FOR TEACHING Demonstrates actions to ensure personal safety Unable to float T Promote head control to prevent Poor breath control T Uses flotation device eg. Displays an awareness of self and body parts Poor coordination and body awareness mouth from entering water kickboard or noodle T Wear goggles T Grasp rail/side of pool independently T Sit in shallow water Decreased use of upper and lower limbs T Breath control activities T Disengagement activities T Action songs ‘Heads and Shoulders’, ‘Open Shut Them’, ‘Hokey Pokey’, ‘Simon Says’ T Rockets by curling up at wall, count down and push off to glide on back T Monkey walks around edge of pool, going to left and right. Make sure both feet are flat on the wall T Obstacle courses over, under, through, on © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers FOUNDATION SKILLS Mild/Moderate Disability SKILL Control body movements LIMITATION Poor head control Poor coordination Lift and turn head IDEAS FOR TEACHING T Breath control activities T Activity songs T Kicking with floatation device in upright position Limited strength and movement T Animal walks eg. frog, chicken, Unable to perform without some assistance T Entry to water and Exit from Fear of water T Walking/running using dog monkey walks, kangaroo Make purposeful limb movements Bring hands to or across midline Change body position Move in water with or without support water techniques T Water Confidence/ Disengagement techniques T T T T T © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers paddle arms Games ‘What’s the Time Mr Wolf?’, water chasey Use flotation devices eg. kickboard, noodle, ring Practice moving from floating on back to standing Monkey walks Dog paddle on stomach with flotation device 15 STAGE 1 Mild/Moderate Disability SKILL Submerge Waist deep Entire head under water LIMITATION Poor balance and strength to move from under the water to a standing position Grommets (2) IDEAS FOR TEACHING T T T T May require a wall/ledge to assist with recovery Teach in waist deep water 1:1 assistance Toys under water as incentive Fear of water Perceptual difficulties Glide forward and recover Waist deep No set distance required Glide Face in water - exhaling Near horizontal body position Arms extended in front of head Problem bending at waist due to increased body extension, stiffness or limited movement Poor coordination/body awareness Unable to hold both arms above head May roll to one side if has hemiplegia Recovery to standing position Poor trunk control Float or glide backward on back and recover Difficulty bending forward from lying on the back to standing Waist deep Flotation aide acceptable T T T T T T T T T No set time/distance required T Near horizontal body position T T Recovery to a standing position Survival Safety/ Sequence No 1 Enter water safely Lack of strength or coordination for exits T T T Use flotation devices for the arms and waist Assist with push off for glide Assist the child with bending at the waist and standing back to upright position Recover to safe position eg. stand at side of pool Break into 2 steps of glide and recover Practice vertical and horizontal body positions Roll onto the stomach then stand Assist with bending at waist and to upright position Head brought upright/forward and hands pushed down in water to assist with recovery Practice floating on back and front Rockets Float on back holding kickboard and kicking Use a rail/ramp/stairs Allow more time Mat at edge of pool Hold flotation aid/float for 10-15 seconds Exit safely from water 16 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers STAGE 1 Mild/Moderate Disability SKILL Enter water safely Shallow LIMITATION Unable to use both arms/legs, due to muscle weakness/ incoordination Slide in entry Fear of water Waist deep water Poor head and trunk control Confident and safe entry and exit (2) IDEAS FOR TEACHING T Entry to water techniques T T Additional practice of bubble blowing activities Blow up a balloon and let air out under water ‘Kangaroo Bobbing’ up and down to variable levels Use goggles/mask to assist with gaining confidence by being able to see under water Demonstrate T T T Goggles Splashing games at face Silicon ear plugs Sensitive skin Poor safety awareness Poor balance uses walker/assistive device Exhale in water Face in Relaxed and confident exhalation Poor strength with exhaling No lip closure - not necessary to have lip closure for exhaling Poor coordination T T T Poor head control Open eyes in water Identify an object under water Visual impairment Sensitive eyes Grommets Confidence Ability to identify an object clearly © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 17 STAGE 2 Mild/Moderate Disability SKILL Glide forward on stomach and kick 3 metres Horizontal body position, face in Waist deep (minimum) Near horizontal body position Face in water, exhaling LIMITATION The face down position may increase involuntary movement patterns IDEAS FOR TEACHING T T T Cycling kick is common Body rotation is common to compensate for an ineffective asymmetrical kick Unable to achieve horizontal position (2) T T T T Continuous kick T T Use a flotation device, eg. noodle, kickboard Check ability to kick from hips or knees Check ankle flexibility. Forward propulsion is difficult if ankles are restricted Flippers assist in a stronger kick Physical guidance at hips for body position Bent arm position is acceptable Kickboard held out in front to practise patter kicking and reduce rotation. Use counting and timing Kicking positions upright, on stomach with flotation device Kicking progressions cycling _ kick with bent leg _ patter kick 18 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers STAGE 2 Mild/Moderate Disability SKILL Glide backward, kick and recover LIMITATION Waist deep (minimum) The face up position may increase involuntary movement patterns, for example, the head and back may arch backwards No set distance Cycling kick is common Arms by side Body rotation is common to compensate for an asymmetrical or ineffective kick Near horizontal body position IDEAS FOR TEACHING T T T T Continuous kick without excessive knee bend Unable to achieve horizontal position T T T T © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers (2) Use a flotation device, eg. kickboard, noodle If the child’s neck is arched back do not push it forward from the back of the head. Guide it forward gently from the top of the head or chin Try a personal flotation device with a head support to encourage the head to bend forward A kickboard or noodle under the pelvis will keep the body horizontally aligned A kickboard held by the child at the chest will reduce the body rotations and keep them more buoyant Physical guidance for body position and kick Begin with child’s head on assistant’s shoulder Kicking positions upright moving towards lying on back 19 STAGE 2 Mild/Moderate Disability SKILL Swim 5 metres freestyle Face submerged Catch up acceptable Effective kick Arm recovery clear of water Face in water, exhaling LIMITATION The face down position may increase involuntary movement patterns Cycling kick is common IDEAS FOR TEACHING T T T T T Body rotation is common to compensate for an asymmetrical kick T T Smooth arm movements may be difficult May not be able to use arms above water or kick symmetrically T Compensate style T T T Scull/tread water (2) Flotation devices Practice catch-up drills with the kickboard Swim action into pool wall Accept dog paddle with modified breathing Physical guidance for sequencing of arm movements Use a kickboard to prevent arms pulling back into the body Accept a modified stroke. For example, one where one arm does not complete a full stroke, it can be considered acceptable providing the distance is completed A kickboard held out in front to practise patter kicking. Flippers assist in keeping legs straighter Kicking positions inclined forwards towards lying on stomach A kickboard held out in front will assist with reducing rotation tendency Allow unilateral breathing Coordination skills T T T T Non-symmetrical action is acceptable Encourage large shoulder movements Floating acceptable Use flotation device eg. noodle, milk container Child may have difficulty maintaining grasp on a rope while being pulled to safety T Use a large object that the child could hold with one or two arms, for example, a two litre plastic bottle on the end of a rope Loop a rope to hold onto. The child may put an arm through the loop and hold the rope with a bent elbow rather than using a hand Using hands and legs to support body weight in water Outward and inward scull Ability to gain some support Alternating leg action Safety/Survival Sequence No 2 Enter water safely Glide forward and kick 3 metres, recover to standing position Holding floatation aid/float for 30 seconds Exit safely from water T Grasp an object and be pulled to safety 20 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers STAGE 3 Mild/Moderate Disability SKILL Swim 10 metres freestyle LIMITATION Free arm movements may be difficult Breathing Near horizontal body position Effective leg action Regular breathing pattern Muscle tightness on one side causing arm to not exit the water, or only complete a short stroke IDEAS FOR TEACHING T T T T T T Control of the volume of breathing may be difficult Asymmetrical kick on one side Excessive body rolling due to muscle tightness on one side of body T T T T T T © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers (2) Practice catch-up drills with the kickboard. Use bar if unable to hold Swim action into pool wall Practise standing in water waist deep Physical guidance for sequencing of arm movements A kickboard in front to encourage straight arms Accept a modified stroke. For example, where one arm does not completely exit the water or one leg does not complete a full kick, it may be considered acceptable providing the requisite distance is completed Catch-up may assist breathing by ensuring an adequate arm stroke during freestyle Encourage use of large shoulder movements Encourage the child to blow air out into the water between breaths. Re-explore bubble blowing games Use flippers to assist the child to focus attention on arms without struggling with legs as well Arm position progressions below _ at _ above water level 21 STAGE 3 Mild/Moderate Disability SKILL Glide backward and kick 5 metres Waist deep (minimum) Arms by side Near horizontal body position Effective kick LIMITATION IDEAS FOR TEACHING The face up position may increase involuntary movement patterns, for example, head and back arched backwards Stroke may not be text book but may be able to achieve distance using ‘freestyle’ stroke T T T Cycling kick is common. Body rotation is common to compensate for an ineffective kick Recovery is hard for children with balance difficulties Demonstrate breast stroke leg action On back (with board) No set distance Circular movement of feet Flexed feet Bending the knees while keeping the hips straight might be difficult Turning the feet outwards may be difficult, if not impossible Do not expect the kick to be symmetrical if there are body asymmetries eg. hemiplegia Unable to turn feet out and up (very common) Demonstrate survival sculling On back Some children are unable to rotate their hand (from their elbow) so the palm faces upwards T T T T T T T T T T Sculling hand action Flat, relaxed hands Effective support 22 (2) T T If the child’s head is arched back do not push it forward from the back of the head. Guide it forward gently from the top of the head or chin. Try a flotation device with a head support to encourage the head to bend forward A kickboard or noodle under the child’s pelvis will keep the body horizontally aligned. A kickboard held by the child at the chest will reduce body rotation Consider propulsion rather than style Use flippers to assist kick Once the child has mastered this stroke while sitting, get them to lie down on their back, legs dangling over the edge. Repeat in pool Use a kickboard held at the chest to assist flotation Use hands-on facilitation Modified stroke or kick action may be considered acceptable provided required distance is completed Consider propulsion rather than style Encourage movement to come more from the shoulders than the elbows Encourage any movement of the arms parallel to water surface Consider propulsion rather than style Use flotation devices © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers STAGE 3 Mild/Moderate Disability SKILL Demonstrate a forward roll LIMITATION Getting into a ball position may be difficult IDEAS FOR T Extension Deeper than waist deep Pushing off from the floor and maintaining a rotatory motion with the arms may be difficult T T Body symmetry may not be achieved and roll will not be straight Water safety sequence No 3 Enter water safely Glide and swim 10 metres before recovering to upright position Grasp a flotation aid thrown for support Float 60 seconds and kick to safety Support body in upright position and signal distress T T T The face down position may increase involuntary movement patterns T T T Cycling kick is common T Body rotation is common to compensate for an ineffective kick T Child may have difficulty maintaining grasp while being pulled to safety T T Recovery to standing may be difficult © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers (2) Encourage the child to keep chin on chest. Assist this by holding the top of the child’s head rather than the back of the head Practice in chest deep rather than waist deep water Practice forward rolls on the grass Practice forming a ball in water Practice duck dives Hands on assistance or guidance Use a rail Allow more time Hands-on physical guidance for body position is acceptable Consider recovery to side of pool and then to upright position Consider using a large object that the child could hold with one or two arms. For example, a two litre plastic bottle on the end of the rope Loop a rope to hold onto or put arm through loop and hold with bent elbow Attach flotation device to student 23 FOUNDATION SKILLS Severe Disability SKILL Demonstrates actions to ensure personal safety LIMITATION Poor head control Unable to keep head above water, float or remain buoyant Fear of water Demonstrates an awareness of self and body parts 24 Poor head and trunk control IDEAS FOR TEACHING T T T T T Use of flotation device 1:1 assistance Use of goggles Breath control activities Promote head control to prevent mouth from entering water T Action songs with physical assistance T Relaxation using flotation Involuntary movements devices © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers FOUNDATION SKILLS Severe Disability SKILL LIMITATION IDEAS FOR TEACHING Control body movement Poor balance and strength T Making splashes T Verbal prompts eg. activity Lift and turn head Poor coordination T Circles with child on back, hold songs Make purposeful limb movements Involuntary movements Bring hands to or across midline Change body position Move in water with or without support Unable to perform independently under arms and spin around in a circle T Seaweeds with child on back with head on shoulder, sway side to side T Starfish float with child on back with legs around your hips and spin in circle T Entry to water and exit from water techniques T Use of ramp with wheeled chair in water T Use hoist/hydraulic lifts T Use of flotation device with propulsion on back or stomach © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 25 STAGE 1 Severe Disability SKILL Enter water safely Shallow Slide in entry Waist deep water POSSIBLE LIMITATION Poor trunk and head control Involuntary movements Unable to stand independently (2) IDEAS FOR TEACHING T T T T Use hoist Use ramp with wheeled chair 1:1 assistance Do not submerge head Confident and safe entry and exit Exhale in water Face in Relaxed and confident exhalation Poor strength with exhaling T Additional practice of bubble blowing activities Do not submerge head T T T Goggles Splashing games at face Silicon ear plugs T Poor head control Aspiration G-tube (= nil by mouth) No lip closure - tongue and jaw thrust Open eyes under water Non verbal Confidence Grommets Visual impairments Sensitive eyes Ability to identify an object clearly 26 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers STAGE 1 Severe Disability SKILL Submerge Waist deep Entire head under water (2) POSSIBLE LIMITATIONS Poor balance and strength to move from under the water to a standing position IDEAS FOR TEACHING T T Use hoist Use ramp with wheeled chair T T Use flotation device 1:1 assistance Assist with bending at waist to upright position Head brought upright and forward with hands pushed down in water to assist with recovery 1:1 assistance Flotation devices with chair G-tube (nil by mouth) Aspiration Glide forward and recover Waist deep No set distance required Fixed range of motion Excessive movement Glide Face in water - exhaling Near horizontal body position Arms extended in front of head Recovery to standing position Float or glide backward on back and recover Involuntary movements T Waist deep Poor head and trunk control T Floatation aide acceptable No set time/distance required T T Near horizontal body position Recovery to a standing position Survival Safety/Sequence No 1 Unable to enter/exit/ independently Enter water safely Hold flotation aid/float 10-15 seconds T T T T Use ramp with wheeled chair Hydraulic lift/hoist Use flotation device 1:1 assistance Exit safely from water © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 27 STAGE 2 Severe Disability SKILL Glide forward on stomach and kick 3 metres Horizontal body position, face in LIMITATION Will need 1:1 assistance to achieve all skills (2) IDEAS FOR TEACHING T T 1:1 assistance Extensive use of flotation device and hands-on physical guidance for body position Waist deep (minimum) Near horizontal body position Face in water, exhaling, continuous kick Glide backward Waist deep (minimum) No set distance Arms by side Near horizontal body position Continuous kick without excessive knee bend Swim 5 metres freestyle Face submerged Catch up acceptable Effective kick Arm recovery clear of water Face in water, exhaling Scull/tread water Use hands and legs to support body weight in water Outward and inward scull Ability to gain some support Alternating leg action Safety/Survival Sequence No 2 28 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers STAGE 3 Severe Disability SKILL Swim 10 metres freestyle Breathing Near horizontal body position Effective leg action Regular breathing pattern Glide backward and kick five metres Waist deep (minimum) LIMITATION IDEAS FOR TEACHING Free arm movements will be difficult T Muscle tightness on one side may make it difficult to complete a stroke T Control of the volume of breathing may be a difficulty, eg. the child may not take a large enough breath or may hold in air © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers (2) T T T T T 1:1 assistance is necessary Encourage use of large shoulder movements Encourage the child to blow air out into the water between breaths. Bubble blowing games Use of flotation device will be necessary Consider propulsion rather than style Use flippers to assist propulsion 29 STAGE 3 Severe Disability SKILL LIMITATION Glide backward and kick 5 metres The face up position may increase involuntary movement patterns, for example, head and back arched backwards Waist deep (minimum) (2) IDEAS FOR TEACHING T T T Arms by side 1:1 assistance Use of a flotation device, positioning at chest, head, knees or pelvis to address individual child’s needs Use flippers to assist propulsion Near horizontal body position Demonstrate breaststroke leg action Child will not be able to coordinate this stroke T T T Sculling hand action Consider relaxation instead with 1:1 assistance Flotation device Use flippers to assist propulsion Flat relaxed hands Demonstrate survival sculling On back Sculling hand action Flat relaxed hands Will be unable to rotate their hand (from their elbow) so the palm faces upwards Will be extremely difficult primarily due to lack of breathing control T T T T T T Encourage any movement of arms parallel to water surface Use flotation device 1:1 assist Do log roll from front _ back 1:1 assist Use of flippers Effective support 30 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers STAGE 3 Severe Disability (2) SKILL Demonstrate a forward roll LIMITATION Will be extremely difficult primarily due to lack of breathing control IDEAS FOR TEACHING T T Do log roll from front back 1:1 assist Extension Deeper than waist deep Water Safety Sequence No 3 Enter water safely Glide and swim 10 metres before recovering to upright position Grasp a flotation device thrown for support Float 60 seconds and kick to safety Support body in upright position and signal distress © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 31 Equipment Available SUGGESTED EQUIPMENT TO USE IN THE WATER Supervision is essential for swimmers when using equipment 32 T Flotation toys to reach for and blow T Swim rings or car tubes, with the valve taped down for the larger swimmer T Noodles bound together in a loop for greater variety, using noodle connectors T Flotation mats T Back bubbles and arm floats can also be used on the legs to encourage greater movement T Hip floats and neck floats T Milk or juice bottles may be easier to hold T Leg and arm floats can be used for smaller children T Kickboards T Reef walkers to protect feet whilst swimming and walking T Wet suit vest to help protect against the cold and for extra buoyancy T Goggles T Flippers © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers List of Contacts AUSTSWIM WA (Inc) The Australian Council for the Teaching of Swimming and Water Safety Telephone: (08) 9227 1530 Fax: (08) 9227 6089 Email: [email protected] Royal Life Saving Society WA (Inc) Telephone: (08) 9383 9988 Fax: (08) 9383 9922 Email: [email protected] Surf Life Saving WA (Inc) Telephone: (08) 9244 1222 Fax: (08) 9244 1225 Email: [email protected] WA Swimming Association (Inc) Telephone: (08) 9328 4599 Fax: (08) 9227 6089 Email: [email protected] WADSA ‘Be Active’ Learn to Swim Western Australia Disabled Sports Association Telephone: (08) 9470 1442 Fax: (08) 9470 3878 Email: [email protected] TCCP The Centre for Cerebral Palsy Telephone: (08) 9443 0211 Fax: (08) 9444 7299 Website: www.tccp.com.au Email: [email protected] Janet Boer-Draffin Developing Skills Telephone: (08) 9310 2746 Email: [email protected] © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 33 List of Contacts IPC Swimming International Paralympic Committee Telephone: (08) 9355 5517 Website: www.ipcswimming.org Email: [email protected] Peppertown Therapeutic Aquatics Equipment PO Box 136 Albion QLD 4010 Telephone: (07) 3265 5666 Fax: (07) 3265 5770 Website: www.peppertown.com.au Email: [email protected] Protramp Australia Aquatics Equipment PO Box 264 Quinns Rock WA 6030 Telephone: (08) 9305 8919 Fax: (08) 9305 8919 Superfins Swimming Club Challenge Stadium Stephenson Avenue Mount Claremont WA 6010 Coach: Phil Jose Telephone: (08) 9341 2644 Wanneroo Aquamotion Swimming Club Civic Drive Wanneroo WA 6065 Telephone: (08) 9306 2882 Joondalup Arena Swimming Club Contact: Rob Bonsack Kennedya Way Joondalup WA 6027 Telephone: (08) 9300 3355 34 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers Acknowledgements The Centre for Cerebral Palsy would like to sincerely acknowledge the contribution and advice of the following people: T All members of the Inglewood Aussi Masters Swimming Club for their continued support of the Jantzen Sorrento Supa Swim. Proceeds of the 1998 Supa Swim were used to fund the development of this resource. Sincere thanks to Jantzen for their generous sponsorship of this event. T Phil Jose and Trevor Goddard (Coaches of the Superfins Swimming Club of the Cerebral Palsy Sport and Recreation Association of WA) for their valuable contributions and ideas. T Janet Boer-Draffin (Developing Skills) for her vast knowledge about swimming with people with disabilities and permission to use her materials. T Mr Gary Shaw (Manager, Swimming and Water Safety Section, Department of Education and Training) for permission to use material from the Swimming Teacher Handbook and constructive advice in the preparation of this manuscript. © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 35 References 36 1) Curriculum Framework for Kindergarten to Year Twelve. Curriculum Council of WA, 1998. 2) Swimming Teacher Handbook and Guidelines. Department of Education and Training, Swimming and Water Safety Section, WA, 1993 3) Janet Boer-Draffin. Swim-Ability Workshop, Assisting People with Disabilities in Water and Teaching Swimmers with Disabilities (Course Notes) 2000 and 2001. 4) Outcomes and Standards Framework for Health and Physical Education. Department of Education and Training of WA, 1998. 5) Children with Handicaps: A Medical Primer, by M.L. Batshaw and Y.M. Perret, Baltimore, 1981. © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers Bibliography Amateur Swimming Association, edited by Joan A. Harrison. Anyone Can Swim understanding and coping with special needs. Austswim (1998). Teaching Infant and Preschool Aquatics. Black A and Black C (1984). Swimming for People with Disabilities Association of Swimming Therapy Ltd. A & C Black (Publishers), London. Blanksby BA (1986). Austswim: the teaching of swimming and water safety. Melbourne, Wilke and Company. Boer-Draffin Janet. Swim-Ability Workshop, Assisting People with Disabilities in Water and Teaching Swimmers with Disabilities (Course Notes) 2000 and 2001. CPAWA Ltd (1996). Cerebral Palsy: An information guide for parents. Perth, CPAWA. Lepore Monica, Gayle G William, Stevens Shawn F. Adapted Aquatics Programming: A Professional Guide Meaney PH (1996). Teaching swimming and water safety. Maryborough, McPherson’s Printing. Royal Life Saving Society (1987). Swimming and lifesaving: the manual. Melbourne, Wilke and Company. Royal Life Saving Society (1996). Aquapak: water safety, survival and swimming skills. Antarman Reid-Campion, Margaret, Heinmann, William (1985). Hydrotherapy in Paediatrics; London. S:\Dept\Childsrv\Pt\Hydro\Swimdoc. © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 37 Notes 38 © 2003 - The Centre for Cerebral palsy - A Guide for Swimming Teachers Notes © 2003 - The Centre for Cerebral Palsy - A Guide for Swimming Teachers 39