{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T17:18:44Z","timestamp":1778087924069,"version":"3.51.4"},"reference-count":3,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiotherapy Res Intl"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Children with severe motor impairments often face significant limitations in physical activity due to high response effort and impaired thermoregulation, leading to secondary physiological decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This hypothesis\u2010generating single\u2010case study evaluated the metabolic and body composition trends associated with an environmental optimization model\u2014utilizing buoyancy and thermoneutral water (36\u00b0C)\u2014in a 13\u2010year\u2010old with a spastic\u2010dyskinetic cerebral palsy phenotype secondary to post\u2010transplant encephalopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An A\u2013B\u2013A\u2032 single\u2010case design was employed. Phase A (baseline) consisted of standard land\u2010based therapy, followed by Phase B (intervention), which included 40\u2010min aquatic sessions twice monthly for 6\u00a0weeks. Phase A\u2032 (withdrawal) monitored the maintenance of any observed changes. Skeletal muscle mass (SMM) and basal metabolic rate (BMR) were measured bi\u2010weekly using bioelectrical impedance analysis (BIA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Visual analysis using the two\u2010standard deviation (2SD) band method showed that during the intervention phase, SMM and BMR values exceeded the 2SD threshold. These positive shifts were maintained during the withdrawal phase. Segmental analysis indicated that SMM increases were localized to the trunk and lower limbs, rather than a generalized growth\u2010related increase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Aquatic intervention was associated with positive trends in metabolic proxy indicators. These findings suggest that for medically complex children with limited physiological reserve, optimizing the therapeutic environment\u2014by reducing response effort and ensuring thermoneutrality\u2014may provide a critical window for enhancing motor engagement and metabolic health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pri.70221","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T13:48:33Z","timestamp":1776520113000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Aquatic Therapy for a 13\u2010Year\u2010Old With Severe Central Hypotonia and Motor Impairment Following Post\u2010Transplant Encephalopathy: A Hypothesis\u2010Generating Single\u2010Case Study"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2692-3857","authenticated-orcid":false,"given":"Tamotsu","family":"Yabumoto","sequence":"first","affiliation":[{"name":"Kagayaki General Home Medical Care Clinic Medical Corporation  Gifu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuumi","family":"Ajioka","sequence":"additional","affiliation":[{"name":"Kagayaki General Home Medical Care Clinic Medical Corporation  Gifu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6468-2138","authenticated-orcid":false,"given":"Hirofumi","family":"Fujii","sequence":"additional","affiliation":[{"name":"Kagayaki General Home Medical Care Clinic Medical Corporation  Gifu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.12660"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011660.pub2"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2007.06.004"}],"container-title":["Physiotherapy Research International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pri.70221","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pri.70221","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pri.70221","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T17:03:13Z","timestamp":1778086993000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pri.70221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":3,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/pri.70221"],"URL":"https:\/\/doi.org\/10.1002\/pri.70221","archive":["Portico"],"relation":{},"ISSN":["1358-2267","1471-2865"],"issn-type":[{"value":"1358-2267","type":"print"},{"value":"1471-2865","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2026-01-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70221"}}