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The Centre for Cerebral Palsy
A Guide For Swimming Teachers
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]
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.
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
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.
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 require some modifications during
swimming lessons and may need concessions to pass levels. • Severe - Children will require equipment and assistance to
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.
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.
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.
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)
1. 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’.
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
(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
Glide forward on stomach and kick 3 metres Horizontal body position, face in Waist deep (minimum) Near horizontal body position Face in water, exhaling Continuous kick
The face down position may increase involuntary movement patterns Cycling kick is common Body rotation is common to compensate for an ineffective asymmetrical kick Unable to achieve horizontal position
T Use a flotation device, eg. noodle, kickboard
T Check ability to kick from hips or knees
T Check ankle flexibility. Forward propulsion is difficult if ankles are restricted
T Flippers assist in a stronger kick
T Physical guidance at hips for body position
T Bent arm position is acceptable
T Kickboard held out in front to practise patter kicking and reduce rotation. Use counting and timing
T Kicking positions upright, on stomach with flotation device
T Kicking progressions cycling _ kick with bent leg _ patter kick
Glide backward, kick and recover Waist deep (minimum) No set distance Arms by side Near horizontal body position Continuous kick without excessive knee bend
The face up position may increase involuntary movement patterns, for example, the head and back may arch backwards Cycling kick is common Body rotation is common to compensate for an asymmetrical or ineffective kick Unable to achieve horizontal position
T Use a flotation device, eg. kickboard, noodle
T 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
T Try a personal flotation device with a head support to encourage the head to bend forward
T A kickboard or noodle under the pelvis will keep the body horizontally aligned
T A kickboard held by the child at the chest will reduce the body rotations and keep them more buoyant
T Physical guidance for body position and kick
T Begin with child’s head on assistant’s shoulder
T Kicking positions upright moving towards lying on back
Swim 5 metres freestyle Face submerged Catch up acceptable Effective kick Arm recovery clear of water Face in water, exhaling
The face down position may increase involuntary movement patterns
Cycling kick is common
Body rotation is common to compensate for an asymmetrical kick
Smooth arm movements may be difficult
May not be able to use arms above water or kick symmetrically
Compensate style
T Flotation devices T Practice catch-up drills with the
kickboard T Swim action into pool wall T Accept dog paddle with modified
breathing T Physical guidance for sequencing of
arm movements T Use a kickboard to prevent arms
pulling back into the body T 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
T A kickboard held out in front to practise patter kicking. Flippers assist in keeping legs straighter
T Kicking positions inclined forwards towards lying on stomach
T A kickboard held out in front will assist with reducing rotation tendency
T Allow unilateral breathing
Scull/tread water
Using hands and legs to support body weight in water
Outward and inward scull
Ability to gain some support
Alternating leg action
Coordination skills T Non-symmetrical action is acceptable T Encourage large shoulder movements T Floating acceptable T Use flotation device eg. noodle, milk
container
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
Grasp an object and be pulled to safety
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
T 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
Swim 10 metres freestyle Breathing Near horizontal body position Effective leg action Regular breathing pattern
Free arm movements may be difficult Muscle tightness on one side caus-ing arm to not exit the water, or only complete a short stroke Control of the volume of breathing may be difficult
Asymmetrical kick on one side
Excessive body roll-ing due to muscle tightness on one side of body
T Practice catch-up drills with the kickboard. Use bar if unable to hold
T Swim action into pool wall T Practise standing in water waist
deep T Physical guidance for
sequencing of arm movements T A kickboard in front to
encourage straight arms T 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
T Catch-up may assist breathing by ensuring an adequate arm stroke during freestyle
T Encourage use of large shoulder movements
T Encourage the child to blow air out into the water between breaths.
T Re-explore bubble blowing games
T Use flippers to assist the child to focus attention on arms with-out struggling with legs as well
T Arm position progressions below _ at _ above water level
Demonstrate a forward roll Extension Deeper than waist deep
Getting into a ball position may be difficult Pushing off from the floor and maintaining a rotatory motion with the arms may be difficult Body symmetry may not be achieved and roll will not be straight
T 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
T Practice in chest deep rather than waist deep water
T Practice forward rolls on the grass
T Practice forming a ball in water
T Practice duck dives T Hands on assistance or
guidance
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
The face down position may increase involuntary movement patterns Cycling kick is common Body rotation is common to compensate for an ineffective kick Child may have difficulty maintaining grasp while being pulled to safety Recovery to standing may be difficult
T Use a rail T Allow more time T Hands-on physical
guidance for body position is acceptable
T Consider recovery to side of pool and then to upright position
T 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
T Loop a rope to hold onto or put arm through loop and hold with bent elbow
Free arm movements will be difficult Muscle tightness on one side may make it difficult to complete a stroke 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
T 1:1 assistance is necessary
T Encourage use of large shoulder movements
T Encourage the child to blow air out into the water between breaths.
Glide backward and kick 5 metres Waist deep (minimum) Arms by side Near horizontal body position
The face up position may increase involuntary movement patterns, for example, head and back arched backwards
T 1:1 assistance T Use of a flotation device,
positioning at chest, head, knees or pelvis to address individual child’s needs
T Use flippers to assist propulsion
Demonstrate breaststroke leg action Sculling hand action Flat relaxed hands
Child will not be able to coordinate this stroke
T Consider relaxation instead with 1:1 assistance
T Flotation device T Use flippers to assist
propulsion
Demonstrate survival sculling On back Sculling hand action Flat relaxed hands Effective support
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 Encourage any movement of arms parallel to water surface
T Use flotation device T 1:1 assist T Do log roll from front _
Demonstrate a forward roll 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
Will be extremely difficult primarily due to lack of breathing control
SUGGESTED EQUIPMENT TO USE IN THE WATER Supervision is essential for swimmers when using equipment 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
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.
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.
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.