Finding Balance: The Halliwick Concept

The Halliwick Concept uses balance to improve the body. Just add water.

Byline: Andrea Salzman, MS, PT

Imagine London, circa 1950. Envision a school full of children whom society has labeled 'crippled.' Picture a school full of girls, all with severe physical and mental disabilities. Then one day, these kids' lives are transformed.

On that day, James McMillan teaches them to swim.

More than 50 years ago, a handful of girls experienced firsthand the therapeutic value of water. Remarkably, not only did the children learn to swim, but they also showed improvement in a host of deficits such as breath control, head and trunk righting, and even self-confidence. Clearly McMillan was on to something.

See original article link or continue reading below.

Today, the ideas McMillan first conceptualized in that school, the Halliwick School for Crippled Girls, are known as the Halliwick Concept. But the original concepts have mushroomed beyond adapted swim instruction and into therapy.

Recognizing that the Halliwick Concept had implications for the therapy world, McMillan and his colleagues brought his ideas about balance and water into the realm of therapists. Think of Halliwick as motor learning in water. McMillan wanted to facilitate maximally possible independence in water, possibly resulting in the ability to swim.

In 1973 McMillan was appointed as the leader of a group to develop exercise therapy in water, using Halliwick principles. McMillan, as an engineer, approached this as an algorithm. The resulting product was known as "The Logic Approach to Exercise in Water". According to Johan Lambeck, clinical reasoning was further added to the mix from clinicians like Urs Gamper. The Logic Approach morphed into what is today called Water Specific Therapy.

Water Specific Therapy is defined as follows: “WST is a therapeutically functional treatment, adapted to the biomechanics of the human body and based on the specific characteristics of water: the buoyancy-gravity relationship, flow conditions and waves.”" Urs Gamper

The Halliwick Concept combines the unique qualities of the water with rotational control patterns in an attempt to facilitate improvements in the body's neurological, musculoskeletal, and psychosocial systems.

In Halliwick, the client is often held or supported in the water by the provider who systematically and progressively destabilizes him in order to teach balance and postural control.

The provider progresses the client through a series of activities, which require more sophisticated rotational control, to teach the client to swim (for adapted aquatics clients) or gain control over movement (for aquatic therapy clients).

The client is continuously required to react to, and eventually to predict, the demands of an unstable environment. Once balance is improved, providers may move their clients toward more independence (for instance, standing or walking) to enable them to perform advanced tasks, such as an obstacle course.

There is no special equipment to purchase if you wish to bring the Halliwick Concept to your pool. Until clients achieve proper balance, Halliwick is performed in a 1:1 relationship without the use of belts, collars or other buoyant devices. Why? McMillan and his colleagues believed that floatation devices were props that would only encourage dependence, not freedom, and that every individual should learn to safely control him or herself in water without any such aids.

McMillan felt strongly that:

Misuse or careless application can mean that well intended therapy fades into merely tender loving care.

Halliwick was originally performed in a cold water swimming environment, but your clients will be more comfortable if it is conducted in warmer temperatures, such as the water found in recreational pools (usually 85 to 89 degrees Fahrenheit) or therapy pools (usually 90 degrees or higher). Water depths of 3 1/2 to 4 1/2 feet will permit instructors to remain grounded on the bottom while holding clients.

It is helpful for the pool environment to be quiet enough to allow clients to hear instructors; however, a silent pool is not necessary as techniques can also be administered non-verbally.

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In 1994, the Halliwick Foundation (HF) and the International Halliwick Association (IHA) were formed to protect and preserve the integrity of the Halliwick Concept. Cases of misuse of the name Halliwick made it necessary for the Halliwick Foundation to register its trademark. The Halliwick Foundation has ceased to exist, but the brand name Halliwick is now in the hands of the IHA.

In 2007, the International Halliwick Therapy Network (IHTN) was formed to further develop the therapy elements of Halliwick. IHTN is now a part of the Association IATF, in which the Halliwick Concept is now taught alongside the Bad Ragaz Ring Method, and other techniques.

Seminars, training manuals, and videos are all available to help the clinician learn the technical aspects of Halliwick. Organizations and facilities sponsoring Halliwick trainings should post their upcoming trainings in the comments section below.

Recent Research:

Alt, D., Alt, N., & Hadar-Frumer, M. (2020). Measuring Halliwick Foundation course students' perceptions of case-based learning, assessment and transfer of learning. Learning environments research, 23, 59-85.

Barrett, U., & Maes, J. P. (2021). The Halliwick Concept according to the ICF Framework. Halliwick.org

Brito, R., Costa, D., Marques, V., Afonso, S., & Cantista, P. Water based therapy in chronic neurological CONDITIONS: A SWIM THROUGH SOME PARTICULAR METHODS. INTERNATIONAL SOCIETY OF MEDICAL HYDROLOGY AND CLIMATOLOGY, 146.

Chandolias, K., Konstantinidou, E., Bikis, E., Hourlia, A., Besios, T., & Tsigaras, G. (2021). The Effectiveness of 6 Months Hydrotherapy Program Based on Halliwick Concept on the Respiratory System of Down Syndrome Children. Journal of Biosciences and Medicines, 9(3), 20-26.

Chandolias, K., Konstantinidou, E., Tsiokanos, A., Moscholouri, C., Besios, T., & Tsigaras, G. (2021). Greek Translation, Content Validity, Test-Retest and Inter-Rater Reliability of Swimming with Independent Measure (SWIM) Assessment Test for People with Disabilities Based on Halliwick Concept. Open Journal of Pediatrics, 11(1), 135-147.

Chandolias, K., Zarra, E., Chalkia, A., & Hristara, A. (2022). The effect of hydrotherapy according to Halliwick concept on children with cerebral palsy and the evaluation of their balance: a randomised clinical trial. International Journal, 9(4), 1.

Gajić, D., Jokić, S., & Mraković, B. (2020). Efficiency of the Halliwick concept in the rehabilitation of children with cerebral palsy. Scripta Medica, 51(3), 174-180.

Grosse, S. J. (2023). The Halliwick Concept: practical applications. International journal of aquatic research and education, 14(1), 8.

Gurpinar, B., Kara, B., & Idiman, E. (2020). Effects of aquatic exercises on postural control and hand function in Multiple Sclerosis: Halliwick versus Aquatic Plyometric Exercises: a randomised trial. Journal of Musculoskeletal & Neuronal Interactions, 20(2), 249.

Hamed, S. A., ElMeligie, M. M., & Kentiba, E. (2023). The effects of Halliwick aquatic exercises on gross motor function of children aged from 3 to 5 years with spastic cerebral palsy. Pedagogy of Physical Culture and Sports, 27(1), 24-31.

Karastamati, C., Chandolias, K., Grammatikou, G., & Hristara-Papadopoulou, A. (2021). The Effectiveness of Hydrotherapy-Halliwick Concept in Children With Juvenile Idiopathic Arthritis: Assessment and Treatment. The Journal of Aquatic Physical Therapy, 29(2), 35-39.

Kemp, E., Woodson, R., & Baldino, M. (2023). Addressing swim safety in autistic children: a pilot feasibility study using aquatic occupational therapy. International journal of aquatic research and education, 14(1), 2.

Tapia, C., Constanzo, J., González, V., & Barría, R. M. (2023). The Effectiveness of Aquatic Therapy Based on the Halliwick Concept in Children with Cerebral Palsy: A Systematic Review. Developmental Neurorehabilitation, 1-6.

Terrens, A. F., Soh, S. E., & Morgan, P. (2020). The safety and feasibility of a Halliwick style of aquatic physiotherapy for falls and balance dysfunction in people with Parkinson's disease: a single blind pilot trial. PloS one, 15(7), e0236391.

Vodakova, E., Chatziioannou, D., Jesina, O., & Kudlacek, M. (2022). The Effect of Halliwick Method on Aquatic Skills of Children with Autism Spectrum Disorder. International journal of environmental research and public health, 19(23), 16250.

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