When asked about Singaporeans’ favourite exercises or sports, swimming usually pops up in the list. Many of us have done swimming as a staple exercise at some point in our lives, leisurely or as a compulsory curriculum. Many parents would also tell their children when they were young that ‘Singapore is an island surrounded by water, therefore you must learn to swim’.

Fear of water aside, getting into the pool is not difficult for many of us. However, for persons with acquired disabilities, such as spinal cord injury survivors, it can be a complex situation to deal with. Questions on accessibility, physical limitations and effects on the changes to body and mind functions after acquiring a disability can affect the participation in this exercise.

So how does a person with acquired disabilities get back into the pool, and what are the benefits of aquatic activities? SPD Transition to Employment’s physiotherapist Dylan Koh have the answers in this episode of the “Have a SPlenDid Day” series.

UPDATES (U): How does aquatic activities benefit spinal cord injury survivors?

Dylan Koh (DK): Aquatic activities are popular treatment modalities for individuals with various medical conditions. Engaging in water-based activity can provide them with therapeutic, psychological and physical benefits.

For a spinal cord injury survivor, being in the water can give the person freedom of movement. The buoyancy and elimination of gravity allow the participant to execute movements in water which may not be possible on land. The turbulences generated by the movement in water challenges the participant to control, co-ordinate and balance his movements, which are essential part of rehabilitation. The resistance in the water also helps with strengthening of various body muscles.

The opportunity to experience different types of activities after acquiring a disability can help to build self-confidence and opens up possibilities of greater independence and social participation as they become motivated to try new things.

U: How can we help a person with spinal cord injuries get into the water?

DK: Depending on the design of the pool and equipment available, there are several methods to enter and exit the pool. For non-accessible pools, the participant will have to perform a wheelchair-to-floor transfer before scooting and sliding into the pool. This can be daunting for a person with mobility challenges as a relatively high level of motor skill is required to execute this transfer.

For participants who are unable to perform a wheelchair-to-floor transfer, they have to be assisted off the wheelchair via the two-person dependent transfer technique, which can be uncomfortable and cumbersome for some individuals.

Fortunately, there are several accessible swimming pools in Singapore. These swimming pools are equipped with ramps and individuals can enter and exit the pool more comfortably and safely using a pool access wheelchair. This minimises the risk of injury and lowers the barriers for participation in water-based activities. We hope to see more inclusive and accessible facilities for individuals with mobility challenges.

U: What ar some considerations when working with a person with spinal cord injuries in the pool?

DK: There are several considerations when working with a person with spinal cord injury in the pool.

Firstly, spinal cord injury survivors may have bladder and bowel dysfunction which may result in incontinence. Therefore, bladder and bowel management before entering the pool is important.

Secondly, monitoring for autonomic dysreflexia is also important. The autonomic nervous system controls body functions like blood pressure, heart rate, body temperature and perspiration, amongst others. The two main systems within the autonomic nervous system are the sympathetic (fight-or-flight) and parasympathetic (rest-and-digest) systems. The body’s reaction to pain or discomfort is to go into the fight-or-flight mode, and the brain then tries to send the rest-and-digest response to counteract the sympathetic response. There is a change in the body’s autonomic reflexes for a person with spinal cord injury above a T6 lesion level.

The injury blocks signals from reaching the spinal cord below the injury level and the body stays in the fight-or-flight mode, which can cause the blood pressure to rise to dangerous levels that can be life-threatening. To put it simply, discomfort such as the water being cold or having a full bladder may cause the body to raise and maintain a high blood pressure. Hence, we need to learn to recognise the symptoms and act quickly to resolve it.

U: How do you help a person with spinal cord injuries to swim again?

DK: Water confidence is one of the key focuses in our hydrotherapy programme as movement in water can be quite different from how they are used to before their disability. For persons with mobility challenges, not knowing how to move in the water can increase their risk of drowning.

To build their confidence in water, we go through various activities to help them understand their body position in water (water familiarisation and breathing control), how their body reacts in water (balance and stability) and movement through water. When they are more confident, we will progress to developing their swimming strokes. Depending on their aptitude, we will adjust level of assistance, modification of strokes and the use of flotation devices to help them stay afloat until they are proficient in their movements.

U: Any tips for persons with disabilities who want to take up swimming?

DK: It is important to first check with their doctors on their physical conditions whether they are suitable for the exercise, as well as have trainers or coaches who have worked with persons with disabilities in the pool. This is necessary for the safety of all parties involved in the pool.

For wheelchair users, it may be useful to have some waterproof covers on hand, such as plastic sheets or large plastic bags, as they can help keep the wheelchair and cushions dry after the swimmer gets back onto it after exiting the pool.

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The “Have a SPlenDid Day” series highlight changes or adaptations that persons with disabilities must make in their everyday lives. We hope sharing of their experiences will help foster greater understanding and disability inclusion in the community. Follow our Facebook, Instagram, LinkedIn, Tik Tok and YouTube @SPDSingapore today!