In an aquatic environment, a small teacher-student ratio is necessary. Mildly mentally retarded students can be served safely in/through small group instruction (1 teacher to four to seven children). Profoundly mentally retarded students require careful, well-trained one-to-one instruction. As many students with mental retardation and developmental delays are outer-directed, that is, dependent upon others for perceptions of self-worth, it is crucial that every attempt is made to structure the learning environment to ensure success.
The most significant strategy for managing the behavior of these students is to "catch 'em being good." Use only the level of support required to maintain performance.
- Verbal praise
- Verbal praise paired with a sign, for example, "thumbs up"
- Verbal praise paired with a physical reinforcer:
- High, medium, low or behind the back "5"
- Pat on the back
- Tangible reinforcers:
- Notes of praise to parents
- Primary reinforcers:
- Goldfish crackers
- M & M's
- Graham crackers
A whole-part-whole approach to instruction appears to be most effective particularly when dealing with stroke skills. The use of David Armbruster's (famous coach of the University of Iowa swimming team and extraordinary swimming teacher) technique in which the student is introduced to all swimming strokes via the human stroke or dog paddle is particularly viable. Once the student can human stroke (dog paddle) on her stomach, each side, and back the very foundation is laid for the development of each of the basic swimming strokes. Then refinement of stroke mechanics and technique can be introduced.
When possible, use the least invasive/directive strategy to provide instruction. Keep verbal instruction simple. Use one-word and two-word directions. If possible, keep verbal instructions simple but age-appropriate. For example, don't ask a teenager to lie on her "tummy;" it is much more appropriate to ask the student to lie on her stomach or to move into a prone position. Pair the verbal instruction with a simple physical demonstration to clarify instruction.
Note: it is vital that the demonstration be done in the same plane as the activity should be performed. For example, it is very confusing for a student with mental retardation to watch an instructor demonstrate the arm pattern for the back crawl with the instructor standing. Preferably, the instructor demonstrates in the water in the proper position; if that is not possible, the instructor should lie on the pool deck to demonstrate. Note: demonstrations by other students may be more effective than demonstrations by the teacher because it may be more motivating to the learner.
If necessary, pair strong tactile and proprioceptive cues using patterning with a simple verbal (or sign) associative cue. For example, hold the student's hand and move it through a pulling motion, pairing that with the word (or sign) "pull". The student with mental retardation will find it easier to manage her own behavior if given the opportunity to choose a particular activity or activity sequence. For example, the teacher can give the student the opportunity to decide if she wants to practice flutter kicking first or practice back float first.
Using "if…then" strategies may be particularly effective in dealing with stubborn students. For example, "If and only if you bob 5 times will you be allowed to play with the beach ball."
Obese students, particularly those with Prader-Willi syndrome and Down syndrome may have a difficult time with "recovery from float" and "recovery from glide" skills because of the high ratio of fat to lean body tissue which causes them to float easily, if relaxed. The recovery skills are crucial and need to be practiced for safety's sake. To spot for recovery from a front float or front glide, the teacher should lay her forearm across the back of the knees and press, while using the verbal cue (or sign) "sit". To spot for recovery from a back float or back glide, the teacher should lay her forearm across the hip crease and press, while using the cue "sit". Vestibular and associated equilibrium deficits in some students with mental retardation may make it very difficult to adjust to the equilibrium dynamics associated with buoyant effects of the water. At first, the students should be given every opportunity to adjust to those dynamics by:
- Using familiar, upright patterns, e.g., walking and jumping in shallow water and, then, gradually moving to chest deep water
- Moving upright with a partner in chest deep water
- Gradually adjusting to horizontal positions with teacher support
- Gradually adjusting to horizontal positions using flutter boards
- Gradually adjusting to independent static positions and movement in horizontal plane
Note: Vestibular and associated central nervous system deficits may make it important for the teacher to allow the student to choose a preferred position and movement in the water. For example, a student may be very uncomfortable in the supine position. Particularly in the older student, this preference should be respected and honored. With younger students, other strategies should be embraced to stimulate the vestibular system and every attempt should be made to help the student develop skills in prone, supine, and side lying positions.
Repetition is key to learning in the student with mental retardation and developmental delays. The instructor can ensure this will happen without boredom by modifying the activity to involve other students and different types of equipment. For example, the student can practice the flutter kick while doing the following:
- Flutter kick while being towed by teacher
- Flutter kick while kicking at a beach ball
- Flutter kick with fins
- Flutter kick "fast" and "slow"
- Flutter kick as part of a song, "If you're happy and you know it…kick your feet…"
There are several contraindicated activities for students with Down syndrome and atlantoaxial instability. These include:
- The butterfly stroke
- Racing dive
- Backstroke flip turn
Individuals with mental retardation may have concomitant conditions that include seizure disorders, heart disease, or may require ear tubes because of significant middle and inner ear infections. A student with epilepsy needs to be carefully monitored in the aquatic environment. Even a student whose epilepsy is controlled should not participate in one or three meter diving events. Scuba diving is probably contraindicated unless a swimmer with epilepsy is paired with a carefully trained partner. Snorkeling may be a safe alternative that allows the same types of opportunities. In the unlikely event the student has a grand mal or psychomotor seizure in the water, allow the seizure to run its course. Under no circumstance should an attempt be made to remove the student from the water to place the student on the deck. The teacher should position herself behind and to the side of the student to gently support the head, neck and shoulders and keep the face out of the water.
The exertion rate of students with mental retardation and a history of heart disease needs to be carefully monitored. Special care should be taken to watch for signs of overexertion - rapid pulse, rapid breathing, flushed face and profuse sweating (often masked in an aquatic environment). If any of these occur, the student should be removed from the aquatic environment and given the opportunity to lie down and rest. A pre-existing plan -- discussed with parents and the student's physician -- should be implemented.
A student requiring ear tubes must use moldable and pliable ear plugs which fit into the ears. Comfortable and relatively stylish head gear is available to keep these in place.
Special considerations must be made for the student with profound mental retardation and developmental delays. Many of these students spend a great deal of the instructional day, or day at home, in wheelchairs, recliners, or positioned on pillows or bolsters. The aquatic environment can afford a student with profound mental retardation a singular opportunity for freedom. There are remarkable flotation devices that can help the student maintain a relatively upright position in the water and allow any action a cause-effect reaction. Abilitations has a catalog specifically devoted to aquatics for individuals with disabilities.
Most aquatic educators do not recommend widespread use of flotation devices when teaching students with disabilities to swim. However, as it is unlikely the profoundly mentally retarded student will learn to swim independently or is independently mobile enough to put self in jeopardy of falling into a pool, etc., the flotation devices simply increase freedom from restraint.
Large flotation mats may be helpful for the student with severe contractures whose only comfortable position is lying on his side. Massage in a warm water environment may be very helpful in maintaining circulation and preventing further contractures.
As many students with profound mental retardation have significant difficulty maintaining thermal equilibrium, care must be taken to watch for signs of overheating ? flushed face and rapid respiration, or of significant cooling ?blue lips, shivering, chattering teeth, goose pimples, etc. The student must be removed from the pool if these signs exist. Students with an educational/medical diagnosis of profound mental retardation may retain significant primitive reflexes which interfere with movement in the water in the same way the reflexes interfere with movement on dry land. The aquatic environment is great for these learners, however, because the buoyancy of the water reduces gravity's impact on movement.
Stomas used for providing oxygen or other nutrients to the body or removing body water must be covered securely with waterproof tape.
Depending on the child's toileting schedule they must wear, if necessary, a catheter or "Huggies Swimwear" or the like. Adults must wear a "Depend" undergarment specifically designed to prevent disintegration when in contact with water or secure plastic undergarments must cover the diapers.
Many students with profound delays respond particularly well to music. Music may be calming and encourage relaxation.
Carol Huettig, Ph.D.
Texas Woman's University
Please reprint only with permission of the author
page last updated 1/2/2013 4:34 PM