Halliwick

Halliwick is a concept, originally developed to teach clients with a (physical) disability to swim and to make them independent in water. The concept was founded by the late James McMillan, an engineer in fluidmechanics. His main aims were participation and independence. Independence is an important prerequisite for participation in therapeutic, vocational or recreational activities in a group: the willingness to lose balance and knowing how to stand up again are core elements.

A Ten-Point-Programme is used to reach these goals. The most important part of this programme is rotational control, also basis for a second part of the Halliwick Concept: Water Specific Therapy (WST). This part is focused on postural control, normalising muscle stiffness and facilitation of movement. Halliwick is mainly used in neurorehabilitation and pediatrics. It has resemblances to Bobath and Conductive education

Halliwick is a problem-solving approach. Possibilities and constraints of the client are analysed in order to use a systematic intervention (Ten-Point-Programme and/or WST) to help the client gain functional increases.

The Ten Point Programme

Mental Adjustment
dissengagment

Transversal Rotation Control
Sagittal Rotation Control
Longitudinal Rotation Control
Combined Rotation Control
Upthrust or Mental Inversion
Balance in Stillness
Turbulent Gliding
Simple Progression
Basic Movement

Fluidmechanics

The fluidmechanical properties of water are the basis for the intervention techniques. As examples:
- turbulent moving water provides resistance, therefore the client will lose balance slowly and has time to react
- the buoyancy provides an easy way to change position, which influences the vestibular system as in sensory integration
- buoyancy forces counteract gravity forces and create rotational torques (metacentric effects). These torques can be used to increase load on connective tissue.

Appplications

Mostly Halliwick is dynamic to facilitate movement and sensory input. Halliwick also has a static part, in which e.g. selective activation of muscles and stabilisation of specific joints is exercised. Halliwick is holistic: the concept can be used to address objectives at all levels of the International Classification of Functioning, Disability and Health ICF.

In neurological and paediatric rehabilitation, clients can experience early mobility. The mechanical advantages of water support the abilities of the trunk in a mobilising and stabilising way. In this sense Halliwick is a constraint-induced movement therapy without the disadvantage of gravity compensation. Many activities easily can be repeated and varied and clients can learn balance- and stumble- strategies, which have carry-over effects to dry land. This application in fall prevention is extended by using obstacle courses or Ai Chi (Noh 2008).

Halliwick also enables a graded activity programme: with low mechanical impact and increasing physiological demand, chronic low back pain patients and others can increase their functional capacity in a mostly joyful way.

References

Lambeck, J., and Gamper U (2011). The Halliwick Concept. In: Becker BA and Cole AJ, eds. Comprehensive Aquatic Therapy, 3rd edition. See [1]
McMillan J. The role of water in rehabilitation. Fysioterapeuten 1974;45: 43-46, 87-90, 236-240
Noh DG et al. The effect of aquatic therapy on postural balance and muscular strength in stroke survivors - a randomized controlled trial. Clinical Rehabilitation2008;22: 966-976

External links

• The history of the development in the UK (1949 – 1970) can be found at [2]