Customizing Lessons for Swimmers with Spina Bifida

Empowering Confidence, Independence, and Joy in the Water — A Compassionate, Evidence-Based Approach 

Swimming is more than a sport for individuals with spina bifida — it’s often a lifeline. The buoyancy of water reduces the impact of mobility challenges, provides resistance for strengthening, and offers a rare sense of freedom and independence. For many, the pool is the only place where movement feels effortless, where they can glide, kick, and explore without the constraints of gravity or assistive devices.

Yet, traditional swim instruction often fails to account for the unique physical, sensory, and cognitive needs of swimmers with spina bifida — leading to frustration, disengagement, or even injury. The solution? Customized, adaptive instruction that honors individual ability, celebrates progress, and prioritizes safety, dignity, and joy.

In this guide, we’ll provide a comprehensive, compassionate framework for instructors, therapists, and caregivers to design swimming lessons that truly meet the needs of swimmers with spina bifida — from beginners to advanced learners.

🌟 Understanding Spina Bifida in the Aquatic Context

Spina bifida is a neural tube condition that affects the spine and spinal cord. The impact varies widely depending on the type and level of the lesion, but common challenges include:      

Muscle Strength & Tone	Low muscle tone (hypotonia), weakness in legs, variable core strength
Mobility & Balance	Limited leg movement, reliance on braces or wheelchairs, difficulty with standing or weight-bearing
Sensory Sensitivity	Reduced sensation in lower limbs — may not feel water temperature or pressure
Bladder/Bowel Management	Requires planning around bathroom access and incontinence
Hydrocephalus	May affect balance, coordination, or fatigue levels
Orthopedic Concerns	Scoliosis, hip dislocation, or joint contractures

“The water doesn’t see spina bifida — it sees a person who wants to move, play, and belong.”— Adaptive Swim Instructor, 20+ years  

🧭 Core Principles for Customizing Lessons

1. Safety First — Always 

• Never leave unattended — even if the swimmer is “independent”

• Use Coast Guard-approved adaptive flotation devices (not water wings)

• Ensure easy access to pool (ramps, lifts, or zero-entry pools preferred)

• Have a clear emergency plan — know how to safely assist with transfers or medical needs 

2. Individualize Everything 

No two swimmers with spina bifida are alike. Tailor every lesson to:

• Level of mobility (paraplegia, diplegia, high vs. low lesion)

• Sensory awareness  

• Cognitive and communication style  

• Personal goals (e.g., independence, fitness, fun, therapy) 

✅ Ask caregivers and therapists:   “What does success look like for them?” “What activities do they enjoy?” “Are there triggers or sensitivities we should avoid?”  

3. Focus on Function, Not Form 

Forget “perfect technique.” Focus on what the swimmer can do — and celebrate it.

• Can they float on their back? → That’s a win.

• Can they kick with assistance? → That’s progress.

• Can they reach for a toy? → That’s independence. 

💡 “We don’t teach strokes — we teach possibilities.”  

4. Use Visual, Tactile, and Repetitive Cues 

Many swimmers with spina bifida learn best through:

• Visual aids: Picture cards, video demonstrations

• Tactile guidance: Gentle hand-over-hand support

• Repetition: Consistent routines and cues build confidence

• Verbal clarity: Short, simple phrases — avoid abstract language 

🎯 Example cue: “Hands on edge. Kick two times. Push up.”❌ Avoid: “Use your core to stabilize” — too abstract.  

🛠️ Adaptive Techniques & Equipment

✅ Essential Equipment       

Adaptive Floatation Vest	Provides buoyancy and trunk support — allows arms to move freely
Pool Noodles	Under armpits, behind knees, or under back for support
Water Walkers or Aquatic Walkers	For standing practice in shallow water
Non-Slip Mats	Prevent slips on wet deck or pool steps
Wetsuit (if cold)	Provides warmth and sensory input; may improve body awareness
Waterproof Communication Board	For nonverbal swimmers to indicate needs (“more help,” “stop,” “fun”)

⚠️ Avoid: Heavy braces or orthotics in water — they can restrict movement and cause pressure sores.  

🎮 Lesson Framework: A 4-Stage Progression

Stage 1: Water Comfort & Trust (Beginner) 

Goal: Build safety, reduce fear, and develop body awareness.

Activities:

• Sitting on pool edge with feet in water

• Splashing hands gently

• Blowing bubbles while seated

• Floating on back with noodle under head and back

• Supported standing in waist-deep water 

Cues:

“We’re safe here.”“Your body is light — like a balloon.”“You’re doing great — I’ve got you.”  

✅ Success Metric: Smiles, relaxed posture, willingness to put face near water.  

Stage 2: Movement & Exploration (Intermediate) 

Goal: Develop controlled movement, coordination, and independence.

Activities:

• Kicking with noodle under thighs

• “Water walking” with walker or hand support

• Reaching for floating toys (encourages arm movement)

• Supported back float with arm reach

• Gentle side-to-side rocking to build core awareness

Cues:

“Kick your feet — like a dolphin!”“Reach for the duck — you can do it!”“You’re moving your body — that’s amazing!”  

✅ Success Metric: Independent movement for 5–10 seconds, initiating actions (e.g., reaching, kicking).  

Stage 3: Skill Development (Advanced Beginner) 

Goal: Introduce basic strokes with adaptive support.

Activities:

• Backstroke: Use floatation vest + noodles — focus on arm movement and rhythm

• Flutter Kick: With board or noodles — emphasize hip movement over knee bending

• Breaststroke: Modified version — small arm scoops, gentle leg movement

• Glide & Push: Push off wall with support, glide as far as possible 

💡 Adaptations: For limited leg movement: Emphasize arm propulsion + floatation For high tone: Use slow, rhythmic movements to reduce spasticity For sensory issues: Use warm water, avoid sudden splashes  

✅ Success Metric: Can perform 3–5 continuous strokes with minimal support.  

Stage 4: Independence & Fun (Advanced) 

Goal: Achieve functional swimming, social participation, and lifelong enjoyment.

Activities:

• Swimming 10–25m with minimal support

• Participating in group games (e.g., “Treasure Hunt,” “Musical Floaties”)

• Joining an adaptive swim team

• Practicing water safety skills:

  • Rolling to back float if tired

  • Grabbing the wall to rest

  • Calling for help using a signal or device

🌟 Celebration: “Look how far you swam!” — not “Look how well you swam.”  

✅ Success Metric: Swims independently for 25m, participates in group activities, expresses enjoyment.  

🧠 Communication & Emotional Support

✅ For Nonverbal Swimmers:

• Use picture cards (e.g., “Go,” “Stop,” “Help,” “More”)

• Observe body language: tensing = discomfort; smiling = engagement

• Use rhythm and repetition — consistent cues create predictability 

✅ For Cognitive or Attention Challenges:

• Keep lessons short (15–30 min)

• Use visual schedules: “First float, then kick, then toy!”

• Offer choices: “Do you want the blue noodle or the green one?” 

✅ For Emotional Regulation:

• Allow breaks — don’t force participation

• Use calming music or songs  

• Celebrate effort, not perfection

• Involve caregivers — they know the swimmer best

⚠️ Safety & Medical Considerations     

Skin Sensitivity / Pressure Sores	Check skin daily; avoid tight equipment; use soft padding
Neurogenic Bladder/Bowel	Schedule lessons around bathroom routines; use waterproof briefs; have a change plan
Hydrocephalus / Shunt	Avoid sudden head movements; monitor for signs of shunt malfunction (headache, vomiting, lethargy)
Orthopedic Issues (Scoliosis, Hip Dislocation)	Avoid deep water if unstable; avoid forced stretches; consult PT before deep water activities
Temperature Sensitivity	Keep water warm (90–94°F / 32–34°C); avoid cold pools

✅ Always get clearance from the swimmer’s pediatrician or physical therapist before starting lessons.  

📅 Sample Weekly Adaptive Swim Plan (Age 7–12)    

Monday	Water Comfort	15 min: Sitting, splashing, blowing bubbles with caregiver
Wednesday	Movement	20 min: Kicking with noodles, reaching for toys, supported back float
Friday	Skill Building	25 min: Backstroke with vest + noodle under arms, 3 x 10m swim
Sunday	Play & Social	30 min: Group game — “Treasure Hunt” with other adaptive swimmers

💡 Always end with a high-five, song, or favorite toy — create positive association.  

Final Thoughts

Swimming isn’t about perfection. It’s about possibility.

For swimmers with spina bifida, the water isn’t just a place to exercise — it’s a place to feel free, strong, and capable. It’s where they discover what their bodies can do — not what they can’t.

Customizing lessons isn’t extra work. It’s respect.

It’s listening. It’s adapting. It’s celebrating the smallest victory as if it were the greatest.

And in doing so, you don’t just teach swimming.

You give someone a gift that lasts a lifetime.

Float. Kick. Smile. Repeat. 

Because in the water, every swimmer — no matter their body — deserves to fly. 💙🏊‍♀️