Speech Therapy in an Aquatic Setting- Interview with Susan Nachimson

Over the last two decades, my innovative work in speech and language pool group sessions has connected me with therapists across the nation.  One of those providers, Susan Nachimson, emailed me after reading my "In the Limelight" interview Water Works in the 2015 ASHA Leader and we have spoken by phone and through emails a few times over the years.  Given her wealth of knowledge, I invited her to share her experiences providing speech therapy in an aquatic setting on my blog.  She was kind enough to take some time to answer questions that are often asked of me via email. 

How did you become interested in providing speech therapy in an aquatic setting?

My first exposure to providing speech therapy in an aquatic setting began in 1987 after I completed the 8-week Neurodevelopmental Treatment (NDT) Course in Pediatrics.   At that time, I was treating a very unhappy and severely involved little one, 2 ½ years with spastic cerebral palsy that affected all limbs and voicing.  He and I were both frustrated and the land activities I had learned in NDT, although sound and logical, were not working.  This child, when spontaneously using voice, exhibited severe laryngeal blocking yielding strident harsh sounds.  He was not a happy camper.  One day during our speech therapy session on the floor of his living room, Mom entered, and I looked up at her and, out of desperation, asked, “How does he like his bath?”   This mom lit up like a Christmas tree!  She excitedly shared how he loved his bath and always laughed when he was in the water.  I was motivated to take him into a nearby, warm pool we were fortunate to have available for people with disabilities.  This little one, who I expected would play in the water with me on the double wheelchair ramp, headed straight into the water!   I followed him and he came up laughing, looked at me as I caught him, and then he dove right back under!  So, the mom and I set it up for him to swim between us and we took turns catching him when his head came up and turning him to repeat the sequence.  We did this the whole session and both of us were amazed!

Whom have you worked with in the water?

The types of clients I have treated include infants through adults with cerebral palsy, Down Syndrome, CVA, Parkinson’s, seizure disorders, Autism Spectrum Disorders, Hearing Impairment, and Attention Deficit Disorders.  In addition, I have treated children with delayed speech and language who overcome resistance when jumping in and out of the water using voicing and early speech!

What are the benefits in working with clients in the water?

In my experience in working with infants through geriatric patients with neuromotor disabilities, the water provides a medium in which these bodies would have less of a struggle to achieve more movement than working against gravity in a land-based practice.  The land then becomes the setting to follow through and facilitate the easy movements attained in water then onto the land setting.  It is a slow, direct, specific process that can have very good results.  And, the fun involved is a plus!

Can you share some information about the coursework you offer in California?

Originally, I taught a class for continuing education for Speech-Language Pathologists because a funding agency was having difficulty paying for SLP services in an aquatic setting as it was not a Standard of Practice for SLPs.   I asked the California Speech and Hearing Association to cover my course and after the first one, they suggested I get my own PDP (Professional Development Provider) number directly from the California Board of Speech Pathology as they had.  So, my courses are supported by the California Board of Speech Pathology for 16-18 continuing education units (PDP129) that are recognized by ASHA and State Licensing Boards as viable Professional Development Units.

My course is an introduction for Speech-Language Pathologists to become acquainted with the various issues we experience and how we treat these or any issues in the aquatic setting.  After taking so many courses to prepare myself for treating clients and patients and teaching colleagues, I realized that I could offer an overview and hands on support for interested SLPs who then could decide to take more courses to address specific issues more oriented to physical and aquatic therapy, if still necessary.  My colleague, who teaches with me, and I have desired to create a manual with anecdotal information and explanations about how we work in water.  However, she is presently working on a PhD in treating Voice Disorders in an aquatic setting, thereby setting a precedence for working in water.  Our manual is on the back burner, so to speak!

Do you offer any online coursework?

I have considered creating a short presentation for basic information on a website and/or online lecture that offers credit for SLPs.  My hesitation is that the hands-on work is specific and serious.  I would not endorse anyone labeling themselves appropriate for treating in the aquatic setting without specific hands on experience.   I have witnessed medical professionals, who have only had a short course with limited experience, labeling themselves experts which has negatively affected patients.

Are there any graduate school programs or certification programs that teach aquatic therapy for SLPs?

My colleague, Rita Alegria, Professora at Universidade Francisco Pesoa, Porto, Portugal, teaches graduate SLP students in an aquatic setting.  It is the only university program that I am familiar with that has a formal program in aqua for SLPs.  I would recommend interested persons consider taking some of these courses at the Universidade. 

Rita enrolled in a speech pathology program in college after she had participated as a professional competitive swimmer from 8 through 22 years of age.  She saw a process for applying aqua principles in working with voicing issues in all aged patients.  Her orientation is totally different from mine where I needed to learn hands on treatment of little ones with cerebral palsy and Down Syndrome.

Many ask about certification for practicing in an aquatic setting and label this as Aquatic Therapy, but to my knowledge, a certification for SLPs is not yet available.  However, as a Speech-Language Pathologist, I, as all of you reading this who are SLPs, know that we practice and provide speech-language therapy in whatever setting we participate.  It seems that the aquatic atmosphere is a modality.  There are many aspects of being able to use that modality to enhance our work. 

In your opinion, can an SLP treat individuals in the water without any formal training?