A little girl with moderate to severe athetoid CP first found freedom of movement using a Wet Vest to jog in the water. This is what her mother said about the experience after one summer. “…the most amazing thing that came out of the water program was independence for my daughter. She is so physically limited, that before the summer, she was never without an adult to hold or support her. Now, in the water she had unrestricted movement. She could swim on her own. We could swim together as a family for fitness or fun. It was the perfect way to enjoy the hot, summer weather. She began to wake up every morning asking to go swimming or saying that she had a wonderful dream that she swam to one place or another with one of her friends. I will never forget the look on her face the first time she jogged from one end of the pool to the other on her own.” Current guidelines suggest a minimum of 60 minutes of vigorous exercise per day to ensure healthy development in able-bodied children. How does a child with an early neurological injury exercise? It is tough. Children with mild to moderate severity cerebral palsy are able to move under their own steam, but they frequently use up the majority of their energy stores just getting from place to place. The work of walking is higher for them. Yet we all know, that if you do cardiovascular exercise, both body strength and endurance increase. The physiology of deep water running has been studied for over 25 years. The technique works and all you need to do it is some deep water and a buoyancy vest. I recommend the Wet Vest for children with a neurological problem. It holds the trunk firmly and provides improved proprioceptive awareness just where it is needed. It is not a life jacket and supervision is still needed, but most children quickly learn to move independently in the water. In my experience, it is possible to change the cardiovascular fitness level and improve mobility in 6 to 8 weeks of regular use 3 to 4 times a week. I have written a simple gait training protocol that is available without charge. The Wet Vest sells new for $135.95 for small children and up to $195.95 for adults. The vests are very durable so used ones may be found on any of the popular lists like eBay. Able-bodied children and adults can use the less expensive flotation belts if needed. These belts do NOT provide sufficient upright support for children with a neurological problem. Children with Hemiplegia have asymmetric movement in the water, as there is less movement of the affected side. In most children, the leg will spontaneously start to move reciprocally with the unaffected leg within a relatively short time. If they have trouble keeping the leg down, put an old running shoe on the affected leg. Jogging in this manner, out of gravity, trains the child’s brain to produce a normal reciprocal movement. If they do not start using their affected arm, they will jog around in circles. In the mildly affected child, they quickly learn how to start using their arm more effectively. Novel, challenging tasks stimulate brain neuroplasticity. If the arm does not start to move spontaneously in a reciprocal pattern, add a small size floatie to the affected arm over the elbow. This will hold the arm straight out from the body, encouraging whole arm movements and strengthening the shoulder muscles. As the child’s strength improves, move the floatie down to just above the wrist… increasing the lever arm. As better reciprocal movement develops, gradually take the air out of the floatie until they are able to do a four-point reciprocal jog on their own. Children with a Brachial Plexus Injury can use the same technique to gradually strengthen the shoulder and arm. Check with your therapist to ensure that there is not too much strain on the shoulder at the start. The therapist may adjust the position of the floatie to get the best effect. For most, starting the floatie high on the upper arm positions the shoulder in a neutral position. Children with Diplegia or Quadriplegia can use all of the above modifications as needed. In more severely involved children with poor head control, a neck flotation collar is also available. Simple, effective and fun. Enjoy the water this summer.