Temporal adaptation of the postural control following a prolonged fin swimming.

PURPOSE: Postural control deteriorates following a transition between two environments, highlighting a sensory conflict when returning to natural conditions. Aquatic immersion offers new perspectives for studying postural control adaptation in transitional situations. Our aim is to study immediate and post-task static postural control adaptation on land after a prolonged fin swimming exercise in total immersion. METHODS: Standing static postural control was assessed in 14 professional or recreational SCUBA divers (11 men, 3 women; 33.21 ± 10.70 years), with eyes open and closed, before, immediately after, and in the following 20 min following a fully-immersed 45-min fin swimming exercise. Centre-of-pressure metrics (COP) including average position, amplitude, velocity, length and 95% ellipse were evaluated in medial-lateral (x-axis) and anterior-posterior (y-axis) directions with a force platform. The Romberg ratio was also assessed for each metric. RESULTS: A two-way repeated measures analysis of variance revealed a significant effect of the measurement period on COPx vel (p = 0.01), COPy vel (p < 0.01) and Length (p < 0.01), and of the visual condition on COPy vel (p < 0.01) and Length (p < 0.01). Eyes closed measures were systematically higher than eyes open measures despite there being no significant difference in the Romberg ratio in all periods. Post-immersion, the velocity and total trajectory of the centre of pressure remained systematically lower than baseline values in both visual conditions. CONCLUSION: Post-immersion, COP velocity and length significantly decreased, suggesting a sensory reweighting strategy potentially associated with ankle stiffening.

Oxy-Inflammation in Humans during Underwater Activities.

Underwater activities are characterized by an imbalance between reactive oxygen/nitrogen species (RONS) and antioxidant mechanisms, which can be associated with an inflammatory response, depending on O2 availability. This review explores the oxidative stress mechanisms and related inflammation status (Oxy-Inflammation) in underwater activities such as breath-hold (BH) diving, Self-Contained Underwater Breathing Apparatus (SCUBA) and Closed-Circuit Rebreather (CCR) diving, and saturation diving. Divers are exposed to hypoxic and hyperoxic conditions, amplified by environmental conditions, hyperbaric pressure, cold water, different types of breathing gases, and air/non-air mixtures. The "diving response", including physiological adaptation, cardiovascular stress, increased arterial blood pressure, peripheral vasoconstriction, altered blood gas values, and risk of bubble formation during decompression, are reported.

Acute aortic dissection during scuba diving.

A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving. After reaching the shore, his chest pain persisted, and he called an ambulance. When a physician checked him on the doctor's helicopter, his electrocardiogram (ECG) was normal, and there were no bubbles in his inferior vena cava or heart on a portable ultrasound examination. The physician still suspected that he had acute coronary syndrome instead of decompression illness; therefore, he was transported to our hospital. After arrival at the hospital, standard cardiac echography showed a flap in the ascending aorta. Immediate enhanced computed tomography revealed Stanford type A aortic dissection. The patient obtained a survival outcome after emergency surgery. To our knowledge, this is the first reported case of aortic dissection potentially associated with scuba diving. It highlights the importance of considering aortic dissection in patients with sudden-onset chest pain during physical activity. In addition, this serves as a reminder that symptoms during scuba diving are not always related to decompression. This report also suggests the usefulness of on-site ultrasound for the differential diagnosis of decompression sickness from endogenous diseases that induce chest pain. Further clinical studies of this management approach are warranted.

[The otolaryngologist's role in evaluating diving fitness]. / Beurteilung einer Tauchtauglichkeit als HNO-Arzt.

Scuba diving and other modes of device-supported diving are popular activities that can be especially demanding and hazardous for people with preexisting physical conditions. Due to the high ambient pressure, the temperature differences, and potential unpredictable events, which have manifold effects on the organism, diving carries a high risk of life-threatening disease. A special risk is present if the body does not readily equalize air pressure changes. Therefore, prior to diving, all divers should undergo detailed education regarding the physical principles of the sport as well as specific physical examination. Consultation of an otolaryngologist is of exceptional relevance because many otorhinolaryngologic diseases can lead to (usually temporary) unfitness to dive. The role of the modern otorhinolaryngologist trained in diving medicine is to correctly advise the patient and restore fitness for diving via conservative or invasive methods.

Scuba diving after a heart transplant: excessive daring or calculable risk?

Over the past 50 years, outcomes after heart transplantation (HTX) have continuously and significantly improved. In the meantime, many heart transplant recipients live almost normal lives with only a few limitations. In some cases, even activities that actually seemed unreasonable for these patients turn out to be feasible. This article describes the encouraging example of a patient returning to recreational scuba diving after HTX. So far, there were no scientific experiences documented in this area. We worked out the special hemodynamic features and the corresponding risks of this sport for heart transplant recipients in an interdisciplinary manner and evaluated them using the patient as an example. The results show that today, with the appropriate physical condition and compliance with safety measures, a wide range of activities, including scuba diving, are possible again after HTX. They illustrate again the significant development and the enormous potential of this therapy option, which is unfortunately only available to a limited extent.NEW & NOTEWORTHY Example for shared decision-making process for tricky questions: First scientific publication about heart transplantation (HTX)-recipient restarting scuba diving. As exercise physiology after HTX combined with specific diving medicine aspects is challenging, we formed a multidisciplinary team to identify, evaluate, and mitigate the risks involved. The results show that today, with the appropriate physical condition and compliance with safety measures, a wide range of activities are possible again after HTX.

Exercise-Related Effects on Executive Functions During a Simulated Underwater Extravehicular Activity.

OBJECTIVE: Investigation of cognitive performance during extravehicular activities (EVAs) in a space-analog setting. BACKGROUND: EVAs performed by humans in microgravity on the International Space Station (ISS) call for high cognitive performance during upper-body workload. Higher cardiovascular demands interact with cognitive performance, but no knowledge exists about EVA's special requirements. This study simulates EVA-training underwater to investigate its effects on the executive functions inhibition and switching. METHOD: In a counterbalanced crossover design, 16 divers (age: 28 ± 2.4 years; eight females) performed two conditions (i.e., EVA vs. Inactivity [INACT]) in 3-5 m submersion (diving gear; not in a space-suit). EVA included 30 min of moderate-, followed by 30 min of high-intensity upper-body exercise intervals, paired with EVA-specific cognitive-motor tasks. INACT included no exercise in submersion and neutral buoyancy. Both conditions included cognitive testing at pre, mid (after the first 30 min), and post (after the second 30 min) on a tablet computer. Reaction times (RTs) and response accuracy (ACC) were calculated for both tasks. RESULTS: ACC was significantly lower during EVA compared with INACT for inhibition (post: p = .009) and switching (mid: p = .019) at post (p = .005). RTs for inhibition were significantly faster during EVA (p = .022; ηp2 = 0.320). CONCLUSION: Specific physical exercise, intensity, duration, and tasks performed during the EVA might differently affect the exercise-cognition interaction and need further investigation, especially for future long-term space travel. APPLICATION: Future research might serve to improve mission success and safety for EVAs and long-term space travel.

Does diving deteriorate hearing functions?

Studies evaluating the hearing function of professional divers have yielded mixed results. In this study, we aimed to observe the effect of diving on hearing function by comparing the audiometry of experienced divers with a non-diver control group. Secondly, we aimed to compare the hearing function among divers according to the diving years and the number of dives in terms of diving exposure. Experienced divers who applied to the University of Health Sciences Gulhane Training and Research Hospital Underwater and Hyperbaric Medicine Department between 2017-2021 for periodic fitness to dive examinations were included in our study. The control group was randomly selected from the non-diver population with similar ages and gender. The audiometry of the control group and the study group was compared. While the control group was found to be better only at 8,000 Hz in the left ear (p = 0.03), there was no difference between the study group and the control group in other frequencies and pure-tone averages. In conclusion, we did not find any evidence regarding the worsening effect of diving on the hearing functions of experienced divers. With the increased awareness of occupational safety in recent years, modern technologies, protective measures, and more conservative diving profiles may have minimized the possible adverse effects of diving on hearing function. Longitudinal studies on hearing functions in the same occupational diver groups should be conducted while observing the effect of different diving profiles and noise exposures.

A fully automated algorithm for heart rate detection in post-dive precordial Doppler ultrasound.

Background: Doppler ultrasound is used currently in decompression research for the evaluation of venous gas emboli (VGE). Estimation of heart rate from post-dive Doppler ultrasound recordings can provide a tool for the evaluation of physiological changes from decompression stress, as well as aid in the development of automated VGE detection algorithms that relate VGE presence to cardiac activity. Method: An algorithm based on short-term autocorrelation was developed in MATLAB to estimate the heart rate in post-dive precordial Doppler ultrasound. The algorithm was evaluated on 21 previously acquired and labeled precordial recordings spanning Kisman-Masurel (KM) codes of 111-444 (KM I-IV) with manually derived instantaneous heart rates. Results: A window size of at least two seconds was necessary for robust and accurate instantaneous heart rate estimation with a mean error of 1.56 ± 7.10 bpm. Larger window sizes improved the algorithm performance, at the cost of beat-to-beat heart rate estimates. We also found that our algorithm provides good results for low KM grade Doppler recordings with and without flexion, and high KM grades without flexion. High KM grades observed after movement produced the greatest mean absolute error of 6.12 ± 8.40 bpm. Conclusion: We have developed a fully automated algorithm for the estimation of heart rate in post-dive precordial Doppler ultrasound recordings.

Altitude Diving on a Closed Circuit Oxygen Rebreather.

Closed-circuit rebreather diving is becoming more common. Rebreathers are complicated, adding to the stress of diving. Also adding to this complexity in the presented case is diving at a high-altitude, cold-water reservoir in Colorado. One diver experienced an oxygen-induced seizure at depth. The other diver had a rapid ascent with loss of consciousness. In this case, two experienced divers recovered from a possible devastating dive. Fortunately, they both returned to their pre-dive baseline health. Dive plan- ning is important, but as in this case, dive execution is paramount. This is a clinical case for an uncommon event presenting to an emergency department.

Bilateral pneumatic blowout fractures in a patient with silent sinus syndrome while diving.

A 37-year-old scuba diver developed sudden severe headache, mid-facial pressure/pain and diplopia while diving. Upon examination, he had signs and symptoms consistent with silent sinus syndrome (SSS), including bilateral enophthalmos, hypoglobus, and diplopia/strabismus in conjunction with CT findings of occluded maxillary sinus ostia, atrophic/collapsed maxillary sinuses, and bilateral orbital floor fractures with fat herniation. As there was no history of trauma or chronic sinusitis, this rare case of bilateral SSS was deemed the cause of the spontaneous fractures (i.e. barotrauma secondary to a lack of equalization to ambient surrounding pressure). Transconjunctival repair of the fractures was successful and maxillary sinus antrostomies re-established aeration of the sinuses. We present this case and its management, as well as review the literature concerning sinus barotrauma as a result of diving and SSS. There have been no reports of orbital fractures primarily caused by scuba diving, nor secondarily from diving with the rare entity, SSS.

Pulmonary barotrauma in SCUBA diving-related fatalities: a histological and histomorphometric analysis.

Arterial gas embolism following pulmonary barotrauma occurs in 13-24% of cases of diving deaths. The study aimed to evaluate the usefulness of a histomorphometric digital analysis in the detection of air space over-distension due to pulmonary barotrauma. The study was performed on lung parenchyma specimens of 12 divers: six had died due to arterial gas embolism following pulmonary barotrauma (mean age at death of 54 years, range of 41-61 years), and six had drowned in saltwater without a diagnosis of pulmonary barotrauma (mean age at death of 54 years, range of 41-66 years) (positive controls). For negative controls, six cases of non-SCUBA divers (mean age of death of 42 years, range of 23-55 years) who died of intracerebral haemorrhage were evaluated. No significant differences were observed in the characteristics of the air spaces between control groups (positive and negative). However, differences were observed in the area occupied by air spaces and the percentage of air space area when we compared the case group to the controls (p < 0.01); and there was a slight difference in the maximum and minimum diameters of air space (p < 0.05). The mean area occupied by air spaces and the mean percentage of air space were the most useful for discriminating pulmonary barotrauma from other causes of death (100% sensitivity and 91.7% specificity). Based on our study, inclusion of an increased pattern of air spaces as a possible diagnostic criterion for pulmonary barotrauma would be useful in discerning the cause of diving death.

Post-mortem computer tomography in ten cases of death while diving: a retrospective evaluation.

INTRODUCTION: Self-contained underwater breathing apparatus (SCUBA) diving deaths have always been a challenge for forensic pathologists. Post-mortem computer tomography (PMCT) allows intracorporeal gas visualization, contributing to identify the cases in which the cause of death is arterial gas embolism (AGE). However, in the literature, it is indicated to perform the radiological examination within 24 h after death. MATERIALS AND METHODS: In this retrospective study, 32 cases of death who had undergone PMCT 24-48 h after death/corpse finding between January 2011 and March 2021 were analyzed, including ten cases of SCUBA divers who died of AGE. All cases' radiological images were reviewed to localize the intracorporeal gas distribution alongside other findings that are usually related to SCUBA diving death. A semi-quantitative evaluation was also performed. RESULTS: Most of the divers showed gas within the left heart and the arteries. In addition, the semi-quantitative evaluation revealed that the divers presented a higher mean amount of intraarterial gas compared to the fresh corpses. On the other hand, the putrefied corpses presented gas within the portal system and generalized subcutaneous emphysema with higher frequency and quantity than the divers and fresh corpses. CONCLUSION: Our cases suggested that the PMCT, even when performed 24-48 h after death, remains a valuable tool to diagnose AGE in cases of SCUBA diving deaths. In addition, with the limit of the small sample size, our data showed that at least a medium quantity of intraarterial gas, when not associated with a high amount of gas within the portal system and subcutaneous emphysema, could be considered a diagnostic criterion of AGE.

Shipwrecks are not the ultimate attracting features in a natural marine environment-the case of Karaburun, Turkey.

Shipwrecks attract divers. Therefore, decommissioned marine vehicles are used as artificial reefs for recreational diving tourism around the world. We examined divers' attitudes towards shipwrecks and their function as an ecological enhancers. The study was carried out in the Karaburun Peninsula, Turkey, where two passenger ships were sunk as artificial wreck reefs to attract diving tourism. Using a questionnaire survey accompanied by face-to-face interviews, of both certified divers and non-certified discovery divers we collected information about divers reefs preferences, perception of artificial reefs as well as their socio-demographic characteristics, dive experiences etc. Differences in divers' wreck (historical or artificial) and reef preferences (natural reefs or artificial wrecks) were analyzed with the Mann-Whitney U test. Overall, divers held the position that artificial wreck reefs provide ecological benefits on fish diversity and stocks (p < 0.05), and experienced divers supported this position more that novice ones. However, experience and number of annual dives did not affect this notion. Non-certified respondents were mostly neutral towards the ecologic and management statements. However, the majority of divers (84%) preferred to dive on natural reefs rather than on shipwrecks. Similarly, most of them (83%) preferred diving to historical shipwrecks which sank in wars or accidents, and not on ships intentionally sunk as attractions. These findings, which are in line with previous literature, put a question mark on the growing practice of sinking nearly any ship to create diving attractions.

Severe carbon monoxide poisonings in scuba divers: Asia-Pacific cases and causation.

Aim: Reports of fatal incidents in recreational scuba divers from carbon monoxide (CO) poisoning are rare. This study aimed to identify scuba fatalities in the Asia-Pacific region caused by breathing-gas contamination to better understand the likely sources of contamination and reduce such preventable deaths. Methods: A hand search of Project Stickybeak reports, subsequent Australian fatality series reports, and of published New Zealand diving fatality reports and associated data was conducted, as well as key word searches of the National Coronial Information System for scuba fatalities in Australia and New Zealand. Cases identified were matched with the Australasian Diving Safety Foundation diving fatality database. Available reports were examined. Results: Four scuba deaths resulting from CO poisoning were identified from 645 scuba fatalities, including one report from each of Australia, New Zealand, Singapore, and the Maldives. A near-fatal incident was also identified in Indonesia. Two of the fatal incidents and the near-fatal incident involved internal combustion engine exhaust gases from the compressor system or elsewhere entering the air intake. Two deaths likely resulted from combustion within compressor systems. Conclusions: Scuba fatalities from CO poisoning are uncommon, albeit likely under-reported. Sources of CO include exhaust gases entering the compressor and CO production by pyrolysis or gasification within the compressor or its filter system. Preventive measures include proper installation (including positioning of the air intake relative to combustion exhaust), appropriate maintenance, fitting of pressure-maintaining valves and avoidance of overheating. Formal training of compressor operators, improved diver education, mandatory requirements for installation compliance assessments, safety inspections, and the use of carbon monoxide alarms are recommended.

Physiological effects of mixed-gas deep sea dives using a closed-circuit rebreather: a field pilot study.

PURPOSE: Deep diving using mixed gas with closed-circuit rebreathers (CCRs) is increasingly common. However, data regarding the effects of these dives are still scarce. This preliminary field study aimed at evaluating the acute effects of deep (90-120 msw) mixed-gas CCR bounce dives on lung function in relation with other physiological parameters. METHODS: Seven divers performed a total of sixteen open-sea CCR dives breathing gas mixture of helium, nitrogen and oxygen (trimix) within four days at 2 depths (90 and 120 msw). Spirometric parameters, SpO2, body mass, hematocrit, short term heart rate variability (HRV) and critical flicker fusion frequency (CFFF) were measured at rest 60 min before the dive and 120 min after surfacing. RESULTS: The median [1st-3rd quartile] of the forced vital capacity was lower (84% [76-93] vs 91% [74-107] of predicted values; p = 0.029), whereas FEV1/FVC was higher (98% [95-99] vs 95% [89-99]; p = 0.019) after than before the dives. The other spirometry values and SpO2 were unchanged. Body mass decreased from 73.5 kg (72.0-89.6) before the dives to 70.0 kg (69.2-85.8) after surfacing (p = 0.001), with no change of hematocrit or CFFT. HRV was increased as indicated by the higher SDNN, RMSSD and pNN50 after than before dives. CONCLUSION: The present observation represents the first original data regarding the effects of deep repeated CCR dives. The body mass loss and decrease of FVC after bounce dives at depth of about 100 msw may possibly impose an important physiological stress for the divers.

Physical Exercise Intensity During Submersion Selectively Affects Executive Functions.

OBJECTIVE: The intact cognitive processing capacity in highly demanding and dynamically changing situations (e.g., in extreme environmental conditions) is of central relevance for personal safety. This study therefore investigated whether underwater physical exercise (PE) affected cognitive performance by comparing these effects during underwater fin-swimming as opposed to inactivity under normal environmental conditions. BACKGROUND: Although acute bouts of PE can modulate cognitive performance under highly controlled and standardized laboratory conditions, no previous study has determined whether PE acutely modulates cognitive performance in non-laboratory testing conditions involving extreme environments (e.g., underwater). METHOD: A total of 27 healthy volunteers (16 males and 11 females; 28.9 ± 7.4 years of age) participated in two experiments involving either moderate or high PE intensity. A PRE/POST crossover design was employed among participants while performing cognitive tests in a counterbalanced order (i.e., before and after 20 min of PE in submersion [WET] and once before and after inactivity [DRY] while in the laboratory). Cognitive performance was measured as a combination of executive functions through the Eriksen Flanker (inhibition) and Two-Back (working memory) Tasks using an underwater tablet computer. RESULTS: ANOVAs revealed enhanced reaction times only in the Flanker test after moderate PE for the WET condition. No other effects were detected. CONCLUSION: These findings indicate that cognitive performance is exercise-intensity-dependent with enhanced effects during moderate PE, even in extreme environments (i.e., underwater). APPLICATION: These results should be relevant in recreational and occupational contexts involving underwater activity and may also apply to microgravity (e.g., during extra-vehicular activities). DESCRIPTION: This study compared the acute effects of physical exercise (PE) on cognitive performance in an underwater environment while participants fin-swam with SCUBA (self-contained underwater breathing apparatus) gear. Findings revealed that 20 min of moderate PE positively affected cognitive performance (i.e., inhibitory control ability). However, no changes were observed after high-intensity exercise.

A fully automated method for late ventricular diastole frame selection in post-dive echocardiography without ECG gating.

Venous gas emboli (VGE) are often quantified as a marker of decompression stress on echocardiograms. Bubble-counting has been proposed as an easy to learn method, but remains time-consuming, rendering large dataset analysis impractical. Computer automation of VGE counting following this method has therefore been suggested as a means to eliminate rater bias and save time. A necessary step for this automation relies on the selection of a frame during late ventricular diastole (LVD) for each cardiac cycle of the recording. Since electrocardiograms (ECG) are not always recorded in field experiments, here we propose a fully automated method for LVD frame selection based on regional intensity minimization. The algorithm is tested on 20 previously acquired echocardiography recordings (from the original bubble-counting publication), half of which were acquired at rest (Rest) and the other half after leg flexions (Flex). From the 7,140 frames analyzed, sensitivity was found to be 0.913 [95% CI: 0.875-0.940] and specificity 0.997 [95% CI: 0.996-0.998]. The method's performance is also compared to that of random chance selection and found to perform significantly better (p≺0.0001). No trend in algorithm performance was found with respect to VGE counts, and no significant difference was found between Flex and Rest (p>0.05). In conclusion, full automation of LVD frame selection for the purpose of bubble counting in post-dive echocardiography has been established with excellent accuracy, although we caution that high quality acquisitions remain paramount in retaining high reliability.

Ten-year Spanish cohort of diving-related injuries in a non-hyperbaric tertiary hospital on the Spanish Mediterranean coast.

INTRODUCTION: Global evidence on the epidemiology of prevalent diving-related injuries (DRI) different from decompression sickness (DCS) and other fatalities is lacking. This study aimed to perform a comprehensive review of DRIs in the year-period between 2010-2020 in a non-hyperbaric tertiary hospital in the Spanish Mediterranean coast, in addition to identifying patient risk factors for severe middle ear barotrauma. METHODS: The study was conducted via a retrospective review of medical records during a 10-year period (2010-2020) at the University and Polytechnic Hospital La Fe (UPHLF) of Valencia. We performed a case-control study recruiting controls through an online survey to identify independent predictors for severe middle ear barotrauma. RESULTS: A total of 68 patients with DRI attended the emergency department of our tertiary referral hospital. Barotrauma accounted for more than 80% of DRI, followed by unrecognized DCS and animal-related injuries. Most patients required neither hospital admission nor surgery; appropriate treatment could be carried out largely on an outpatient basis. The presence of subsequent sequelae was minimal. Previous presence of significant ear, nose and throat (ENT) comorbidities (OR 3.05 - CI 95% 1.11 - 8.35), and older age (OR of younger age 0.94 - CI 95% 0.91 - 0.98) were identified as independent risk factors for severe middle ear barotrauma, with an acceptable discrimination capacity (AUC 0.793, 95% CI 0.71 - 0.87). CONCLUSION: The incidence of DRI may be higher than previously thought, and the need to know their epidemiology, their associated morbidity, and the deficiencies of the diving management system is becoming steadily important in order to develop prevention, diagnostic and therapeutic protocols in non-hyperbaric hospitals of these regions.

Ultrasound in decompression research: fundamentals, considerations, and future technologies.

It is widely accepted that bubbles are a necessary but insufficient condition for the development of decompression sickness. However, open questions remain regarding the precise formation and behavior of these bubbles after an ambient pressure reduction (decompression), primarily due to the inherent difficulty of directly observing this phenomenon in vivo. In decompression research, information about these bubbles after a decompression is gathered via means of ultrasound acquisitions. The ability to draw conclusions regarding decompression research using ultrasound is highly influenced by the variability of the methodologies and equipment utilized by different research groups. These differences play a significant role in the quality of the data and thus the interpretation of the results. The purpose of this review is to provide a technical overview of the use of ultrasound in decompression research, particularly Doppler and brightness (B)-mode ultrasound. Further, we will discuss the strengths and limitations of these technologies and how new advancements are improving our ability to understand bubble behavior post-decompression.

Water-Based Interventions for People With Neurological Disability, Autism, and Intellectual Disability: A Scoping Review.

The purpose of this study was to produce a descriptive overview of the types of water-based interventions for people with neurological disability, autism, and intellectual disability and to determine how outcomes have been evaluated. Literature was searched through MEDLINE, EMBASE, Ovid Emcare, SPORTDiscus, Google Scholar, and Google. One hundred fifty-three papers met the inclusion criteria, 115 hydrotherapy, 62 swimming, 18 SCUBA (self-contained underwater breathing apparatus), and 18 other water-based interventions. Common conditions included cerebral palsy, spinal cord injury, Parkinson's disease, and intellectual disability. Fifty-four papers explored physical outcomes, 36 psychosocial outcomes, and 24 both physical and psychosocial outcomes, with 180 different outcome measures reported. Overall, there is a lack of high-quality evidence for all intervention types. This review provides a broad picture of water-based interventions and associated research. Future research, guided by this scoping review, will allow a greater understanding of the potential benefits for people with neurological disability, autism, and intellectual disability.