title: Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review.
abstract: OBJECTIVE
  To review the literature on the effects of aquatic intervention on gross motor skills for children with cerebral palsy (CP).
  
  
  METHODS
  Six databases were searched from inception to January 2016.
  
  
  METHODS
  Aquatic studies for children aged 1-21 years with any type or CP classification and at least one outcome measuring gross motor skills were included. Information was extracted on study design, outcomes, and aquatic program type, frequency, duration, and intensity. Quality was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale.
  
  
  RESULTS
  Of the 11 studies which met inclusion criteria, only two used randomized control trial design, and the results were mixed. Quality of evidence was rated as moderate to high for only one study. Most studies used quasi-experimental designs and reported improvements in gross motor skills for within group analyses after aquatic programs were held for two to three times per week and lasting for 6-16 weeks. Participants were classified according to the Gross Motor Function Classification System (GMFCS) levels I-V, and were aged 3-21 years. Mild to no adverse reactions were reported.
  
  
  CONCLUSIONS
  Evidence on aquatic interventions for ambulatory children with CP is limited. Aquatic exercise is feasible and adverse effects are minimal; however, dosing parameters are unclear. Further research is needed to determine aquatic intervention effectiveness and exercise dosing across age categories and GMFCS levels.
authors.affiliation: a Department of Occupational Therapy , School of Rehabilitation Sciences, Isfahan University of Medical Sciences , Isfahan , Iran.|b Musculoskeletal Research Center , Isfahan University of Medical Sciences , Isfahan , Iran.
authors.forename: Meysam
authors.initials: M
authors.lastname: Roostaei
authors.affiliation: b Musculoskeletal Research Center , Isfahan University of Medical Sciences , Isfahan , Iran.|c Department of Physiotherapy , School of Rehabilitation, Isfahan University of Medical Sciences , Isfahan , Iran.
authors.forename: Hamzeh
authors.initials: H
authors.lastname: Baharlouei
authors.affiliation: a Department of Occupational Therapy , School of Rehabilitation Sciences, Isfahan University of Medical Sciences , Isfahan , Iran.|b Musculoskeletal Research Center , Isfahan University of Medical Sciences , Isfahan , Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Azadi
authors.affiliation: d Research Center for Children with Special Health Care Needs , Franciscan Hospital for Children , Boston , Massachusetts , USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Fragala-Pinkham
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D006875:Hydrotherapy / Q000009:adverse effects / Q000379:methods*; D007223:Infant; D009048:Motor Skills / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aquatic exercise; aquatic intervention; aquatic therapy; hydrotherapy; swimming