Halliwick for Stroke Rehabilitation

Effects of Halliwick on Functional Mobility in Subacute Stroke Patients: A Randomized Controlled Trial.

By Tripp F and Krakow K. From the Department of Physiotherapy, Asklepios Neurological Hospital Falkenstein, Königstein/Taunus, Germany, October 2013

About The Halliwick Concept

The Halliwick concept originally developed to teach people with physical disability to swim and make them independent in water. Mostly Halliwick is dynamic to help movement and sensory input. In rehabilitation, people can experience early mobility. The mechanical advantages of water support the abilities of the trunk in a mobilising and stabilising way. In this sense Halliwick is a constraint-induced movement therapy without the disadvantage of gravity compensation. Many activities easily can be repeated and varied and people can learn balance and stumble strategies, which have carry-over effects to dry land.

The Study

The aim of this study was to evaluate the effects of The Halliwick concept (aquatic physiotherapy method) on mobility in the post-acute phase of stroke rehabilitation.

Adult patients after first-ever stroke in post-acute inpatient rehabilitation randomly assigned to Halliwick Therapy Group (n=14) and Control Group (n=16).

In the Halliwick-Therapy group (n=14) a two weeks treatment included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week.

Subjects in the control group (n=16) received conventional physiotherapeutic treatment over a period of two weeks five times per week.

The primary outcome variable was postural stability (Berg Balance Scale). Secondary outcome variables were functional reach, functional gait ability and basic functional mobility.


On Berg Balance Scale (P < 0.05), the Halliwick-Therapy group attained significant improvement:

  • Halliwick-Therapy group – 83.3%
  • Control Group – 46.7%

Functional gait ability improvements (P < 0.1) were significantly higher in the Halliwick-Therapy group:

  • Halliwick-Therapy group – mean (SD) 1.25 (0.86)
  • Control group – mean (SD) 0.73 (0.70)

Improvements in functional reach and basic functional mobility were not statistically significant between groups.

This study indicates that the Halliwick concept as a form of rehabilitation in water, is safe and well tolerated for stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility.

References: PMID: 24177711SAGE PublicationsInternational Halliwick Association (IHA)Wikipedia