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Writer's pictureAndrea Salzman

ATU Model Letter of Medical Necessity for Aquatic Therapy: Cerebral Palsy

Updated: 19 hours ago

Aquatic Therapy University (www.aquatictherapist.com) offers this model letter of medical necessity for clinicians who desire to outline the benefits of aquatic therapy for a child with cerebral palsy, supported by recent evidence from the medical literature.


You may use the letter as provided below for your own practices.




[Date]

[Insurance Company Name]

[Insurance Company Address]

[City, State, ZIP Code]

Re: [Patient's Name]

Date of Birth: [Patient's DOB]

Policy Number: [Policy Number]


To Whom It May Concern,


I am writing to request coverage for aquatic therapy for my patient, [Patient's Name], who has been diagnosed with cerebral palsy. Aquatic therapy is a clinically supported intervention that has demonstrated significant benefits for children with cerebral palsy, including improvements in motor function, enjoyment, activities of daily living, and health-related quality of life.


Motor Function and Enjoyment: Lai et al. (2015) demonstrated that children with spastic cerebral palsy who participated in aquatic therapy had greater improvements in the Gross Motor Function Measure and higher Physical Activity Enjoyment Scale scores compared to a control group.[1]


Functional Abilities: Rohn et al. (2021) highlighted the positive impact of the Halliwick method on motor skills and functional abilities in children with cerebral palsy.[2]


Balance and Mobility: A systematic review by Getz et al. (2006) found that aquatic interventions significantly improved body functions and activity levels in children with neuromotor impairments, including cerebral palsy.[3]


Quality of Life: A study by Shariat et al. (2024) showed that aquatic therapy had a more robust positive effect on motor and social skills, as well as executive function, compared to land-based exercises in children with neurodevelopmental disorders.[4]


Physical Competence: Güeita-Rodríguez et al. (2021) reported significant improvements in physical competence and school functioning in children with cerebral palsy following aquatic therapy.[5]


Given the robust evidence supporting the efficacy of aquatic therapy for children with cerebral palsy, I strongly recommend that [Patient's Name] be approved for this intervention. Aquatic therapy will provide [Patient's Name] with a comprehensive and effective treatment option that addresses multiple aspects of their condition, ultimately leading to improved quality of life and functional outcomes.


Thank you for your consideration of this request. Please feel free to contact me if you require any additional information or documentation.


Sincerely,

[Your Name]

[Your Title]

[Your Contact Information]

[Your Address]

[City, State, ZIP Code]


References

  • Lai, C. J., Liu, W. Y., Yang, T. F., Chen, C. L., Wu, C. Y., & Chan, R. C. (2015). Pediatric aquatic therapy on motor function and enjoyment in children diagnosed with cerebral palsy of various motor severities. Journal of child neurology, 30(2), 200-208.

  • Rohn, S., Novak Pavlic, M., & Rosenbaum, P. (2021). Exploring the use of Halliwick aquatic therapy in the rehabilitation of children with disabilities: A scoping review. Child: care, health and development, 47(6), 733-743.

  • Getz, M., Hutzler, Y., & Vermeer, A. (2006). Effects of aquatic interventions in children with neuromotor impairments: a systematic review of the literature. Clinical rehabilitation, 20(11), 927-936.

  • Tufekcioglu, E., Konukman, F., Kaya, F., Arslan, D., Ozan, G., ERZEYBEK, M., & Al-Sawi, E. (2021). The effects of aquatic watsu therapy on gross motor performance and quality of life for children with cerebral palsy. Montenegrin Journal of Sports Science and Medicine, 10(2).

  • Shariat A, Najafabadi MG, Dos Santos IK, et al. The Effectiveness of Aquatic Therapy on Motor and Social Skill as Well as Executive Function in Children With Neurodevelopmental Disorder: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2024;105(5):1000-1007. doi:10.1016/j.apmr.2023.08.025.









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