CORE Metadata, citation and similar papers at core.ac.uk Provided by Archivio istituzionale della ricerca - Università di Palermo Acta Medica Mediterranea, 2018, 34: 2147 NEUROPSYCHOMOTRICITY IN WATER: A NEW REHABILITATIVE TOOL FOR NERUODEVELOPMENTAL DISORDERS MARIA RUBERTO1, BEATRICE GALLAI2, GABRIELE TRIPI3,4, FRANCESCO LAVANO5, MARGHERITA SALERNO6, S ERENA M ARIANNA L AVANO 5, PALMIRA R OMANO 7, D ANIELA R USSO 8, R OSA M AROTTA 5, S ABRINA F RANCO10, ELISABETTA P ICCIOCCHI 11,12, DIEGO GERACI 10, M ARIO GIUSEPPE C HISARI 13, GABRIELLA MARSALA14, ANNA NUNZIA POLITO15, MICHELE SORRENTINO16, ROSARIA MARTINA MAGLIULO17, LUCREZIA D’ORO18, ANNABELLA DI FOLCO9, LUCIA PARISI9, DAVIDE TESTA9, PAOLO MURABITO19, FRANCESCO CERRONI20 1 CDR Santa Maria del Pozzo, Somma Vesuviana, Italy - 2Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy - 3Department PROSAMI, University of Palermo, Italy - 4Childhood Psychiatric Service for Neurodevelopmental Disorders, CH Chinon, France - 55Department of Health Sciences, University “Magna Graecia”, Catanzaro, Italy - 6Sciences for Mother and Child Health Promotion, University of Palermo, Italy - 7Centro di Riabilitazione LARS, Sarno, Italy - 8Centro di Riabilitazione La Filanda LARS; Sarno, Italy - 9Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy - 10Department of Medical, Surgical and Advanced Technology Sciences G.F. Ingrassia, University of Catania, Catania, I-95123, Italy - 11Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy - 12Casa di Cura Villa dei Fiori Acerra, Napoli, Italy - 13Istituto nazionale della previdenza sociale (INPS), Catania, Italy - 14Struttura Complessa di Farmacia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy - 15Complex Structure of Neuropsychiatry Childhood-Adolescence of Ospedali Riuniti of Foggia, Foggia, Italy - 16NICU -Preterm and High Risk Newborn Neurodevelopmental Follow-up Service; Pineta Grande Hospital Castel Volturno (CE), Italy - 17Centro Studi Della Scoliosi S.R.L, Italy - 18Centro Ambulatoriale Santo Stefano, Pesaro, Italy - 19Università degli Studi di Catania, Catania, Italy - 20Centro Manzoni s.r.l., Napoli, Italy ABSTRACT Neuropsychomotricity in water is a rehabilitative practice that avails itself just of the liquid element, as a mediator of relationships: in water yes they upset all dynamics, be they relational, of equilibrium, of movement and perception, due to the fact that proprioceptive sensations, created by bodily contact with water, they are different than those generated by contact with air. Keywords: neuropsychomotricity, pediatric rehabilitation, water. DOI: 10.19193/0393-6384_2018_4s_330 Received July 17, 2018; Accepted Septemper 20, 2018 Introduction Neuropsychomotricity in water is a rehabilitative practice that avails itself just of the liquid element, as a mediator of relationships: in water yes they upset all dynamics, be they relational, of equilibrium, of movement and perception, due to the fact that proprioceptive sensations, created by bodily contact with water, they are different than those generated by contact with air. The psychodynamic characteristics of water Water, in addition to having physical characteristics, also has characteristics psychodynamic; just think of what it evokes, creates, stimulates and induces, for find psychodynamic contents. In fact, water is a mediator, it adheres, touches, envelops and brings out the emotional need. It combines relaxation, abandonment, promoting bodily contact, intimacy. It allows the perception of the ego, the harmonization of processes psy- chics with bodily emotions and regression, on an imaginary level, of the primary relationship in the arms of someone who contains you and cradles you. Being a feminine and maternal symbol as it welcomes, it fills the spaces, it fills the gaps, it is one of the most important aspects of psychological life of the child, since it favors union, separation, identity, through the evolution that goes from the dependence of body to body, to autonomy, passing from progressive separation. Water with its characteristics, with its symbols, with the fantasies that can stimulate, bring out situations removed and / or forgotten, becoming, therefore, as emotion, that is, it gives the possibility to free oneself from emotions. It can provoke shouts of affirmation and aggression, when yes beats and dominates, but, having the power not to break, free from the sense of fault when it is hit with enthusiasm, since it returns perfectly intact. On the other hand, water can also scare, as it is immersed in it metaphor of a journey, which is therapy, is the discovery of a new world, é sail to the unknown; in these cases it is necessary to use rituals reassuring, including playing on the edge of the pool, which recalls the rituals greeting to get away from what is certain. Diving (detaching from the ground), requires a lot of physical energy, it is a gesture that it needs a coordination that is the result of experience, but it is also an act impulsive, an illusion, a challenge; it means eliminating what inhibits e blocks, overcome fear, because, for as long as you are in the air, yes they defy the laws of gravity, they deceive themselves of being able to detach themselves from the ground. The sketch takes on the connotation of liberation, provocation, joy, recall and catharsis, then prevails the affective connotation of the gesture and the relational dimension. In wallowing the pleasure of the sensory-motor experience is found, for example, in a puddle, considered a reassuring transgression, in how much you touch the bottom and there is no danger of getting lost; its boundaries are extremely limited, sketches invite you to experience the violation of customs. Floating means facing the different physicality of water, requires one act of trust, because everything that is new or different scares. It is an act of trust first of all towards oneself, that is, in one's positive part, that it can do it, but also towards the therapist, as a guide in which surrender; it is therefore to let oneself go to the tonic dialogue with one's own body, to lose oneself in the equilibrium of the relaxation, to annul the resistances and the tensions. Sinking, is considered as a point of arrival of security in the help relationship and it means abandoning completely to the other, that is ready to intervene for you. Diving (as mentioned earlier) means losing control, let yourself go to the unknown; through this one experiences the estrangement, isolation from ordinary life, which is seen differently, with greater mental flexibility. It is therefore possible to experiment with the use of immersion as an experience of overcoming fear, loss of boundaries and seeking well-being absolute. Under water the children, even if suffering from very serious pathologies, get better, they spread their arms, smile and let go and, when the adult intervenes to make them return to the surface, oppose, agitate and try to disengage. Not all of them are predisposed to immerse themselves, in fact, the claustrophobic and the agoraphobics do not want to immerse because, being surrounded from the water without reference points, it does not allow them to adapt. Neuropsychomotricity is a discipline that proposes the harmonious development of the motor, sensory, perceptive and praxic attitudes of the child and promotes, through the methods and the global exercise of motor skills, not only muscular and articular activity, but also the integration of the corporeity in spatial and temporal terms, as well as the construction of thought through the mental representation of the completed motor action and of the communication processes, proposing the unitary concept of a person(1-10). Neuropsychomotricity in water is a rehabilitative practice that avails itself just of the liquid element, as a mediator of relationships: in water yes they upset all dynamics, be they relational, of equilibrium, of movement and perception, due to the fact that proprioceptive sensations, created by bodily contact with water, they are different than those generated by contact with air. Water promotes in particular the integration of the disabled child, in how much on earth the difference from normality is evident with others children, while in the water, finding themselves in a new environment for everyone, a hostile environment to dominate and win, these experience moments of equality, fostering their trust, security and mental serenity(11-20). Moreover the water, thanks to its density and its heat, supports, envelops, contains, massages and models how the air cannot do and, thanks to his buoyancy, offers a feeling of lightness, which Neuropsychomotricity in water: a new rehabilitative tool for neruodevelopmental disorders allows the child to recover perceptive plans, impossible in a therapy room with children weighing more than 10 kg and taking on new positions, never tested first, thus perceiving activity as a pleasure, not as a therapy. The aquatic environment creates resistance to movement and gesture, giving way to the child to reflect on patterns that he perceives outside automatism. Activate unconscious elaborations on the tonic plane, which are translated on the postural plan and that of the investment of space. Indeed, water it acts as a total intermediary between oneself and others, without intervening necessarily touch and / or contact. It redraws the body schema, giving a perception of its boundaries and brings into play the consciousness of the body unity, in the relationship between the inside and outside, inside and outside, just think of children with problems integration (shattered), to the sensations they could experience and theirs way of being in the water. In it, they are altered: the perception of one's own body immersed, still and in motion, and there is greater stimulation of sensitivity exteroceptive of the cutaneous and muscular sensations, or of signals that allow you to be aware of the continuous variations, respectively: of the posture, that is the position in the space of some segments of one's body compared to others, and balance, position that deals with space. It can therefore be inferred that everything that happens in water is neuropsychomotor, since there is movement, relationship, emotion. His practice can be considered a physical dance, given that helps to facilitate any movement of the immersed parts, gives the body agility and grace, facilitates rounded movements, harmonic, rhythmic, allowing the child to find himself in a situation that induces pleasure, well-being, playful moments. The pool becomes a place for creativity and research, which allows the child to experiment, explore, find, find, be welcomed and see and represent reality in a different way, even outside of it. For all these reasons, practice in water will positively influence everything the psychomotor development of the child, with a positive interest, not only of motor skills, but also of the emotional, cognitive and relational area, (given that the child finds infinite stimulation effects in the aquatic, information suitable to favor and regulate cognitive processes and rebalances emotional-affective)(21-35). Obviously, in order to obtain these benefits, it is necessary to make the practice a pleasant experi- 2149 ence for the child and focus on the emotional relationship, to give the chance to get in touch with his own unconscious, putting in place a relationship of sharing, which takes therapeutic value. In fact, until recently, it was widely believed that water favored the onset of diseases mainly by cooling and, when used in rehabilitation, it had only an assistance purpose: yes he intervened on the pathology and not on the individual as a whole. At present, the scientific and pedagogical presupposition on which this practice is based is that of investing in resources and residual capacities, even if minimal, that these subjects possess and, through an incessant reinforcement action, allow the achievement of objectives both in the sphere of autonomy in other areas of personality, given the correlation between the different aspects of it(36-50). So the final objective of this practice is no longer aimed only at recovering the damage, when possible, but at the complete development of the child's capabilities and potential through the use of the game: the psychomotorist must have the awareness that, on the one hand, a physical deficit compromises the body's ability, both motor and mental, on the other, the psychic deficit affects cognitive, affective, relational and, consequently, functional functions. With whom to practice it? Neuropsychomotor therapy in water is particularly indicated for: 1) Children who can not assimilate experiences, or so-called children: “unstable”, those who spend their lives without being able to stop, those for which listening is impossible, watching does not become see, for they work in the water is: find a place where “to be”, in which to express themselves, in which to design, construct a gesture, a movement linked to an action. Here the feedback is immediate, the act takes shape and the dive, the swim, the spraying or avoiding spraying allows you to move to levels of consciousness, where you can direct the experience, assimilate it and then access one thought structure. 2) All children with relational distortions that, through the recovery of an aquatic dimension, an archaic relationship can be played with the other, where the functional level can be mediated by a reality plane objective represented by the pool space, by the use of time, in the metaphysical reconstruction of a self-identification. Here presence / absence, proximity / distance, self-centeredness and omnipotence yes they play on deep symbolic planes, in a transpar- 2150 ent universe but visible, which cushions and enhances both experiences. 3) That category of children who have difficulty entrusting themselves to others and to the pleasure of the game. Here the water dimension favors the opening to the sense-motor pleasure, where the peculiarity of the element in its slowing down, soften, accompany, emphasize movement, allows the child to feel without emotion is pervasive, intrusive, overwhelming. And the pleasure that motivates motivation; it is the desire that sustains it. Therefore in the water those children learn to grow through an experience unthinkable outside it. 4) Those who, outside a sensory-motor experimentation, live the symbolic game in the static state of the creative states, in the immobility of the body, where the imagination creates and transforms, enhancing the fantasmatic connotations, preventing the transition to more mature thought strategies. The work in water enhances the reality plan, creating unusual levels of body use, where nothing is taken for granted by favoring that use of space, of time and of the object in a symbolic key, which allow a representation mental more consistent and adherent. 5) Children who find difficulty and develop a coherent tone e functional, regardless of the cause, because through a mediator more dense air can make themselves aware of the gesture, of its direction, force, speed and the effects it produces on the sensitive plane. In addition to the effects on movement, this work, through recognition of a causal relationship, allows the children in question to enter the time parameter. Thanks to the tonic, mediated dialogue, from the body of the therapist, in one element uniformly felt on the kinesthetic plane, allows to recover the dimension of a corporeal self as whole in its parts(51-60). When and for how long to practice it? Neuropsychomotor therapy in water can be practiced: 1) At the beginning of neuropsychomotor therapy, to eliminate the automatisms or restructure a body. 2) In the course of therapy in a therapeutic situation too long time, to find new incentives. 3) At the end of therapy, to mark a separation from the room and begin to establish a separation process. In any case, it certainly starts after a good observation in room and there are no fixed rules, Maria Ruberto, Beatrice Gallai et Al almost all the motivations are linked to the history of the child, its therapeutic history, the validity of the project, ai times and the objective to be achieved. The duration of the practice in water will be decided by the team, based on the comparison between the prefixed objectives and those achieved by the child and will be, always the latter, to decide whether to carry out all the sessions in the water or to keep some of them in the hall. Even if you usually prefer to combine them, unless it is proposed only at the end of the path. The fun activity in the water The game is a means of symbolic expression, of profound thoughts, which it does emerge emotions, frustrations, fears, uncertainties and gives voice to those disturbances that fail to translate into words and can not be heard in the world of adults. Hence its therapeutic value. During the practice in water it is important not to ask in a directive way, but give ample space to the spontaneous activity of children as an exchange relational, allowing them to experiment in relation to the material without too many verbal explanations, to facilitate the discovery and self-awareness. In this way the swimming pool becomes a privileged space for games and games relationship: symbolic space of affective and emotional representations, where gesture, action, act become expressions of the imaginary that it takes the form of free and spontaneous play(60-99). The beginning of the meeting, in fact, is always based on spontaneous play, so that the child can experience the use of the material and invest it symbolically, for example: the tube becomes a horse, a sword, a shotgun; the mattress a boat and a bathrobe a transformation machine. You can also practice symbolic games, representing some “Symbolic characters” such as: 1) The sailor: simple and courageous man who faces the sea, often solitary sailor who takes care of himself alone in any circumstance. He rarely stops in a port and vice versa is led to constantly change the direction of his life. 2) Pirates: negative heroes, but fascinating adventurers, they live a life without rules, or rather they build new and transgressive rules. I'm brave, throw themselves into the boarding, live in the employ of a boss, but they also have a marked aptitude for identification in the group. Neuropsychomotricity in water: a new rehabilitative tool for neruodevelopmental disorders They are often marginalized and rejected looking for social redemption. 3) The pearl fisherman: challenges the fear of diving and the dangers that ad it is connected, receiving a treasure as a reward. His short trip and repeated it evokes the need to live in another world. You can also represent “places”, for example: - The island (the houseboats): confined place, well defined and often isolated from the rest of the inhabited world. Associated with adjectives like lost, mysterious, savage, it is also not a place like in the tale of Peter Pan. It is the place to hide or search for the treasure, it is also the shipwreck’s landing. Or again you can represent marine animals such as: 1) The seal: belonging to both the aquatic and terrestrial world, is emblematic of laziness and indolence, alternates the elegance of movement when it is in water with awkward movements when it is on dry land. 2) The dolphin: an animal with a strong social life that lives in a couple and breeds its own little ones. Defends the comrades attacked by predators and assists the weak or the sick. It appears frequently in the symbolism of the savior. 3) The whale: significant for its size, comes from the Greek “ketos” which means big fish. It takes on a meaning similar to that of the ark in different cultures. 4) The octopus: symbol of nonsense, but also as opposed to cunning, lives on the bottom and is camouflaged and then jump on the prey with his tentacles. It therefore evokes images of ambiguity and opportunism, of vulnerability and subtlety. 5) The shark: unpredictable and terrifying, its ferocity goes beyond what happens. His mouth full of sharp teeth is enough to evoke the anguish and the fears of the monstrosity that is inside each of us. We continue with the structured game through functional paths, comparisons, dog or horse races, even coming to stage a story, a movie, various fantasies or inventions. Water allows you to make games different from those on earth, as it is reassuring because, despite being manipulated and fragmented, it is not it never breaks. The separations that the child induces in the liquid element si cancel alone, the water always returns whole and united. 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Probiotic in Lamb Rennet Paste Neuropsychomotricity in water: a new rehabilitative tool for neruodevelopmental disorders 78) 79) 80) 81) 82) 83) 84) 85) 86) 87) 88) 89) 90) 91) Enhances Rennet Lipolytic Activity, and CLA and Linoleic Acid Content in Pecorino Cheese. Journal of Dairy Science 2009; 92: 1330-1337. Messina G, Di Bernardo G, Viggiano A, De Luca V, Monda V, Messina A, et al. Exercise increases the level of plasma orexin A in humans. J Basic Clin Physiol Pharmacol. 2016; 27(6): 611-6; Messina G, Palmieri F, Monda V, Messina A, Dalia C, Viggiano A, et al. Exercise causes muscle GLUT4 translocation in an insulin-independent manner. Biol Med. 2015; 7 (Special issue); Messina G, Viggiano A, Tafuri D, Palmieri F, De Blasio S, Messina A, et al. Role of orexin in obese patients in the intensive care unit. J Anesth Clin Res. 2014; 5(3) Monda M, Viggiano A, Viggiano A, Viggiano E, Messina G, Tafuri D, et al. 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The diagnosis of fatal pulmonary fat embolism using quantitative morphometry and confocal laser scanning microscopy. (2008) Pathology Research and Practice, 204 (4), pp. 259-266. DOI: 10.1016/j.prp.2007.12.010 Turillazzi, E., Neri, M., Cerretani, D., Cantatore, S., Frati, P., Moltoni, L., Busardò, F.P., Pomara, C., Riezzo, I., Fineschi, V. Lipid peroxidation and apoptotic response in rat brain areas induced by long-term administration of nandrolone: The mutual crosstalk between ROS and NF-kB. (2016) Journal of Cellular and Molecular Medicine, 20 (4), pp. 601-612. DOI: 10.1111/jcmm.12748 _________ Corresponding author LUCIA PARISI Department of Psychology, Educational Science and Human Movement University of Palermo (Italy)