by Ruth Orman, Special to the Catalyst

Nimble as a baby seal, 8-year-old Zach Gravino scoots and splashes his way to the pool's edge, all the while improving his flexibility, coordination, and ability to do the crawl.

But he couldn't care less about all that. Guided in his efforts by his instructor, first-year MUSC student, Lisa Hart, Zach's primary interest here is, in his own words, "kicking and splashing."

Zach's sheer delight in the water activity is but one example of the daily scenarios that underscore Nancy Osborne's assertion that the "true essence of life is joy and peace." For the children she oversees, neither occurs in isolation nor by rigid format. Osborne, the new executive director of the Christian Family Y, is referring to the Y's expanded adaptive aquatics program. The program, a swimming curriculum specially designed for children with disabilities, pairs volunteer student instructors from MUSC and the College of Charleston with a clientele of children who sorely need a therapeutic recreational outlet.

A three-year grant, provided by MUSC, has infused the program with enough funding to make the program available to more families. The grant is part of MUSC's Healthy South Carolina Initiative, which forges partnerships between MUSC and community organizations to enrich quality of life.

For Zach, who has Down's syndrome, the program's primary benefit provides something most of us take for granted, the joy of play, from every wellness angle, physical, emotional, social, and psychological. In tandem with crucial water safety skills, the adaptive aquatics program is a source for improved quality of life for children whose social outlets are limited because of physical or mental health conditions.

"It supplies a recreational outlet for kids who can't just get up on a bike or put on roller blades and go for a cruise," said Jane Charles, M.D., an MUSC assistant professor in the Division of Genetics and Child Development. "If you teach them swimming and how to be comfortable in a pool at this age, then it's a particular activity they can do and benefit from for the rest of their lives. And hopefully it will generalize into functional daily skills."

Charles, in conjunction with Osborne and Sharon Brandenburger-Shasby, OTR/L, assistant professor in MUSC's Department of Rehabilitation Sciences, Occupational Therapy Educational Program, consulted on the project's various aspects. Charles knew of Osborne's work through patient referrals she has made to the Y's adaptive aquatics program. She also knew that Osborne, formerly the Y's aquatics and fitness director, had run the show herself, as instructor and supervisor, for four years. Charles and Brandenburger-Shasby, are MUSC colleagues. They all concurred that it was an ideal opportunity for students and patients alike.

"The Charleston community provides opportunities for our students to observe, learn, and participate in early childhood and school settings, community, and health care facilities," said Brandenburger-Shasby. "Based on the scouting philosophy of leaving the campground a better place than when you found it, I believe our students benefit from the give and take of sharing skills, knowledge, and resources."

The therapy pool used in adaptive aquatics is heated to 94 degrees Fahrenheit (standard lap pools are 83 degrees). The extra warmth creates an aquatic massage therapy haven, that facilitates exercise, thereby increasing muscle flexibility, reducing anxiety, and relieving stiffened joints. Unbound from gravity, the children are free to explore their potential within the Y's pool, which features a hydraulic lift, wide steps, hand railings and water jets that line the pool, and shallow water seating, all specifically designed to assist those with special needs. At three-and-a-half feet deep, it is the perfect therapeutic playground for the program's 6- to 11-year-olds. The physically disabled are released from wheelchairs and braces into a world of buoyancy. For complex sensory disorders, such as autism, the water calms and centers their outlook.

Adaptive aquatics is ideal for this diverse group of children, many of whose health considerations, also include cerebral palsy, mental retardation, spina bifida and visual and hearing impairment, and preclude standardized formatting in favor of a more dynamic, flexible learning style. The same principle of flexible teaching also applies to the student instructors.

"I started trying to train the teachers with a series of sequential steps, but personally I don't put a lot of weight in overplanning," Brandenburger-Shasby said. "Everything just can't be in a little compartment and all spelled out. The ones who have come into this knowing the least about swimming, who had no blueprint in their head about how to do this, have accomplished the most. Without a format, they were able to work out this new creation. If you have the desire to do this and can relate to the children, you will teach them to swim."

However seemingly disparate are these children's health complications, one vital aspect is consistent among them all: the need for a recreational outlet that would not otherwise be available. Few, if any, recreational programs will provide disabled children with swimming lessons, because they're either not equipped to do so or provide group lessons only. In fact, only two aquatic therapy pools exist in the state, with the other being in Florence, according to Osborne. Moreover, the adaptive aquatics program is customized to meet the children's and parent's needs. Sessions are scheduled around work and school schedules, and the children are paired with their instructors according to each child's needs and the therapists' skills.

Most important of all, the therapy is one-to-one, between child and instructor, providing individualized support for each child's particular needs. In fact, the one-to-one bonding of child and instructor is critical to the lesson's success.

"Trust is key," Osborne said. "The kids and their instructors are introduced to one another in the context of play, and the teacher takes the cue from the kids. You can relate in the context of play with almost anyone and they can relate back. Whereas if you put them in any other context, without play, you can squeeze the life out of it. You've got to let a child in a play environment explore, physiologically, aesthetically. Everything has to be learned by doing it and experiencing it."

Among adaptive aquatics' potential benefits are increased independence and self-esteem. Children with disabilities, said Charles, often have a heightened sense of their vulnerabilities. As do their parents, who are used to advocating beyond the norm for their children and becoming a part of their child's activities. Standard Y policy doesn't allow parents poolside during any swimming lessons, whether routine or adaptive, in order to decrease the children's distraction from the lessons. The adjustment has provided parents with the unanticipated benefit of bringing them together within a group of common empathy, a springboard for sharing their experiences, reducing their sense of isolation, and educating one another.

At a cost of $71,358 per year for the program, the funding provides student instructor training, lifeguards, lessons, therapy pool maintenance, and other ancillary costs. The goal is to eventually include the program in Charleston County School District's annual budget to fund physical education for special needs children.

To date, the bulletin board behind Osborne's office desk, listing all participants, has not had one name erased since the program's start in February. Student volunteers commit to a session (eight, one-hour lessons) with the option to extend. Class credit is not part of the program. But this has not deterred the 79 student instructors. Forty-five are currently in rotation, with the others on standby and awaiting volunteer opportunities. Forty of the total are MUSC students. Moreover, the rapport among the student instructors, their proteges, and parents is so well forged that all of the children are maintaining their partnerships into the project's next quarter.

Charles and Brandenburger-Shasby are designing studies that objectively measure the children's comfort around water, water safety skills, actual swimming ability, their one-to-one relationships with their instructors, their self-esteem and compliance, and their translation into functional daily activity.

As for getting the word out, Charles, Brandenburger-Shasby, and Osborne agree that the adaptive aquatics program is taking on a life of its own.

“This is the way a program like this works," says Osborne. Everybody else panics because there's not going to be a lot of publicity. I don't worry about this because there are a million kids dying for this to happen. I say just keep going. We never have to look back. We're solidly in place. The parents are interested, the kids are loving it, the teachers are loving it. It's working. It's all going forward. It makes the kids happier, more productive, and more fulfilled. What better thing could there be in life?"

The Christian Family Y is seeking more student instructor volunteers for the summer months. MUSC students interested in participating in this program, or anyone interested in $50 scholarships that support a child's eight lesson session can call Osborne at 723-6473.