I don't mean swimming lessons. In this episode of Coral Currents, I sat down with Elise Makalous, a physical therapist and Coral Care provider who's spent this summer doing home- and community-based aquatic therapy, to talk about water as a therapeutic medium — and why it works on kids in ways land never quite manages.
Elise has been a PT for almost 15 years, always in pediatrics, and aquatic therapy found her rather than the other way around. "This is something that has totally come up for me," she told me. "I've always done pediatrics... and after having conversations with families and them expressing the desire and how difficult it is to find professionals who are trained to work with their child and feel comfortable doing it in the water — hey, I can do that."
What struck me was how she talked about the properties of water — buoyancy, viscosity, hydrostatic pressure — not as textbook terms but as tools she reaches for on purpose.
Buoyancy gets filed under "less pain, less weight-bearing," but for kids with abnormal tone, it's something bigger: a way to move without gravity in the equation at all. "We think about those kids on land who are just constantly battling against gravity," she said. "And all of a sudden we can put them in water and thanks to that buoyancy we can give them an opportunity to move in a way that they can't move when gravity is in the equation." And hydrostatic pressure — the deep, constant pressure of a submerged body — does something land-based therapy usually has to split into two separate moves. "It's like you're able to do all of the exercises that you would be doing in a therapy session while you're also wrapping up a kid in a weighted blanket and rolling them around on the floor," she said. "On land we have to choose one or the other."
The story I keep coming back to is one of her current kiddos — an eight-to-ten-year-old with autism who struggles with core strength, focus, and staying in one place on land. In the pool, he slows down without anyone asking him to. "It regulates him," Elise said. "It makes things harder for them to do." No verbal prompt, no visual schedule — just water doing what water does to a nervous system.
We also got into the honest, unglamorous parts: how she decides aquatic therapy is actually the right call (it usually starts with a parent mentioning a pool), why she doesn't put her manual-handling kids in life jackets ("I like to be able to do traction through the back of their spine... and I can't do that very well with a life jacket"), and why she stays out of swim-safety training for kids who elope, because that's not her comfort zone even though it's squarely someone else's specialty. She was refreshingly blunt about equipment, too — her go-to tool is a pool noodle looped and zip-tied into a ring. "There's so much I can do with that $1 pool noodle and a zip tie," she said, laughing. "Sometimes people go, 'Oh gosh, I'm gonna need all these special things to get my kids in the pool' — and very much that's not the case."
Elise was clear that none of this replaces land-based work — she always evaluates on land first, and the pool exists to serve the same goals, not invent new ones. But she was just as clear about what the water gives her that land can't: trust. "When you get that kiddo in your hands, and you feel them relax against the pool, and they start to trust you — that is so special," she said. "You get to take off that effect of gravity that they're feeling all day."
If you want more aquatic-specific resources, Elise pointed to the Swim Angelfish water-safety webinar for kids with autism, along with APTA's aquatics section.
That's a wrap on Season 2 — thank you for spending it with us. We'll be back with Season 3 soon.
Listen to the full episode of Coral Currents with Elise Makalous on Spotify.
