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Living with Epilepsy

Swimming

Swimming and Epilepsy

Introduction

This booklet was originally prepared by the National Co-ordinating Committee on Swimming for the Disabled.  The Mersey Region Epilepsy Association is grateful to them for their permission to reprint.

The question of whether people with epilepsy should swim has for many years aroused controversy, not least among members of the medical profession.  To consider this subject further the Co-ordinating Committee set up a working party.  This comprised members in the medical, para-medical, baths management and instruction fields, together with a representative from the British Epilepsy Association.

This booklet is the result of their deliberations.  The Committee is most grateful to the British Epilepsy Association for their help in producing material and to their medical committee for vetting it.  Inevitably, the controversy will continue but we hope that the information and advice offered will help to allay fears and enable more people with epilepsy to enjoy swimming.

Should people with epilepsy swim?

For the sake of their own safety, people should learn to swim.  People with epilepsy, and especially children, are subjected to all sorts of restrictions and it is particularly valuable for a sport like swimming to remain open to them.  Some children with epilepsy have poor coordination, which makes many sports difficult, so swimming is of even greater benefit to them.

It is much safer for people with epilepsy to swim with their condition known about and, if they are banned, many of them will continue to swim without disclosing it, to the possible danger of themselves and others.  However, there are potential risks for all those liable to epilepsy.

It is desirable to encourage a relationship of trust between Baths Management and people with epilepsy.  If the latter know that they will not be turned away on account of their handicap, they will be more likely to reveal it and this is really in the interests of all concerned.

The Epilepsy Associations have always advised people with epilepsy, and especially parents of children with epilepsy, to seek their GP’s approval for swimming, and in this connection the following considerations should be taken into account:

How dangerous is a seizure in the water?

Under controlled conditions it is minimal.  Fatal or even serious accidents are rare, but have been known to occur.  Studies in Australia and Hawaii show the absolute risk of drowning as a result of an epileptic seizure is low, though children and adults who are mentally or physically handicapped – are at greater risk.  Good baths management, however, should reduce this risk considerably.

How can swimming be made safe for people with epilepsy?

By recognising the problem.  Allow them to swim only if accompanied by a responsible companion, i.e. someone who is a strong and capable swimmer (and preferably is a qualified life-saver).

The companion should also be able to recognise a seizure immediately it starts and must be physically capable of supporting the person he is responsible for in deep water, or the bather should be restricted to the helper’s standing depth.

How can a seizure be recognised in the water?

Watch for loss of coordinated movement.  Some people with epilepsy continue the activity they were performing in the early stages of the attack, but their stroke becomes uncoordinated and starts to break up.  Direction becomes vague and involuntary head movements may start.

How can a seizure be dealt with?

First priority is to keep the face above water, and it is best to approach the swimmer from behind.  If it is possible, tow him to shallow water and hold his head until the attack passes.  He will do less damage to himself in water than on land if his breathing is functioning.

However, after the convulsion is over, the swimmer should be removed from the poolside.  If breathing has stopped, normal resuscitation measures should be taken.  Close surveillance of someone liable to tonic-clonic seizures is especially necessary, and familiarity with the particular type of seizure is obviously desirable on the part of the companion.  Absence seizures are brief, but the swimmer may suddenly sink.  Staff should be familiar with first aid measures in case of tonic-clonic seizures.

Is medical assistance necessary?

No, provided resuscitation is not required, there is no injury and one seizure does not follow another without the person regaining consciousness in between (status epilepticus).  This is rare, but when it does occur it is a medical emergency and help should be summoned immediately.

General Points

Suggestions for Schools

Going swimming at school means that the child must be observed on a one-to-one basis, and it may therefore not be possible, unless a parent who can swim accompanies the child and observes from the side of the bath.

The Epilepsy Associations are now advocating the adoption of the “pairing” system - known as the “buddy” system in the USA. If, in any swimming session, all children were expected to swim in pairs it would provide additional safety for weaker swimmers and for children with epilepsy. In the latter case it would have the advantage of not drawing attention to their condition because the procedure would be general.

The benefits of the system are many.  It enables life-saving to be taught in pairs and encourages an awareness of the safety of others while developing confidence in the less able.

It is customary in the USA to use the system at summer camp and on school holidays, as well as for conventional class sessions.  A whistle is blown once or twice during the session and swimmers must be able to touch each other immediately.  Failure is penalised by forfeiting the rest of the session or the following one.

The Epilepsy Associations would welcome the introduction of the scheme into all schools and would be pleased to send staff to assist its implementation with general advice.

Conclusion

This leaflet is mainly concerned with swimming in indoor public swimming pools.  When people with epilepsy swim in clubs or in private pools the question of liability is different.  Swimming in outdoor pools, the sea, in rivers or any cold water below 75ºF is not recommended.

The social and psychological benefits of swimming for someone with epilepsy are great, but there are certain risks because of its unpredictability.  This leaflet is concerned with showing how these risks can be minimised, so that people with epilepsy can join openly in an activity from which they have too often been excluded in the past, rather than perpetuating the much greater hazard of swimming without disclosing their condition.

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