Featured Rehab Stroke

Let’s get STARRT-ed: Empowering stroke survivors with access to aquatic therapy

St. John's Rehab therapeutic pool
Written by Anna McClellan

Scientists in Sunnybrook’s St. John’s Rehab Program are advancing rehabilitation science by conducting person-centred, collaborative research that focuses on optimizing long-term outcomes for persons with stroke experience. Researchers Dr. Andresa Marinho Buzelli, Dr. Sander Hitzig and Dr. Marina Wasilewski, recently introduced the Stroke Toolkit for Aquatic Rehabilitation and Recreation Therapy (STARRT), a digital guide to optimize the access and use of aquatic therapy for persons with stroke experience, health care professionals and caregivers.

The toolkit was uniquely co-designed by an interprofessional group of researchers, allied health professionals, stroke organizations and people with lived stroke experience, to create a person-centred, inclusive experience for users to learn about and access aquatic therapy.

“STARRT is the first aquatic therapy toolkit developed at Sunnybrook,” explains Dr. Marinho Buzelli, STARRT project lead. “This unique toolkit will help deliver a more specialized aquatic therapy experience to persons with stroke experience across Canada.”

The need for a stroke toolkit for aquatic rehabilitation

Stroke is a medical emergency resulting in a sudden loss of brain function and is often caused by an interference with blood flow to the brain. In Canada, stroke is the leading cause of adult disability as it can result in restricted movement, paralysis and impaired speech even after medical intervention. For many persons with stroke experience, the road to recovery is long and filled with many challenges. Aquatic therapy, which involves exercise in water, has been shown to have several benefits for people recovering from a stroke.

“I’ve had the chance to observe how aquatic therapy has changed the lives of so many with stroke experience,” says Shaylene Leibl-Smith, a recreation therapist at Saskatchewan Health Authority and a member of the STARRT advisory team. “From stress and pain management, freedom of movement, confidence building and connecting with others, it’s rewarding to see the progress individuals can make participating in aquatic therapy.”

Sharing lived experience to empower survivors

Danny Foran is the patient partner that is sharing his own stroke journey to help and empower other survivors. As a member of the STARRT co-design team, Danny’s experience using aquatic therapy informed some of the benefits, exercises and caregiver supports identified in the toolkit.

Dr. Marinho Buzelli and Danny

Dr. Marinho Buzelli, STARRT project lead, and Danny Foran, transferring his experience with stroke to help design the toolkit.

In 2012, Danny suffered a serious stroke that left him paralyzed on the left side of his body. In addition to different on-land rehabilitation exercises like physiotherapy, Danny joined an aquatic therapy club for stroke survivors. Since pursuing aquatic therapy, Danny has felt an improvement in his balance, strength and endurance, and has even learned how to swim using his right arm.

“Not only has swimming helped me physically, but it’s also supported my mental health since suffering my stroke,” explains Danny. “Swim clubs like the Oakville Strokers allow survivors to meet with each other in and outside the pool, which is a very empowering and motivating experience.”

Rehabilitation can be a frustrating experience for persons with stroke experience, who struggle with movements and activities that they could do before having a stroke. Danny hopes that sharing his experience to design resources like STARRT, will help survivors on their rehabilitation journey, and provide them with both physical and mental benefits and comfort.

“It’s been rewarding to participate in the design process of STARRT,” adds Danny, “I’ve been able to transfer my knowledge of aquatic therapy into an accessible tool for others.”


Danny participating in aquatic rehabilitation after suffering a stroke that left him paralyzed in one side of his body.

Optimizing recovery through aquatic therapy

STARRT is designed to teach persons with stroke experience, caregivers and health care professionals about the benefits of aquatic therapy, answer questions about what to expect from an aquatic therapy class and showcase aquatic therapy pool locations across Canada via an interactive map.

There are currently over 700 pools in Canada that patients and caregivers can explore in the STARRT toolkit. From swimsuits to medications to snacks, STARRT also provides a list of what you might need at an aquatic therapy session, as well as different strengthening, balance, aerobic exercises and games you can try in the pool.

“When designing STARRT we wanted persons with stroke experience to inform the foundation of the toolkit,” adds Dr. Marinho Buzelli. “The goal of this project is to help persons with stroke experience reap the physical benefits from aquatic therapy, and feel more confident and independent in their functional ability by providing them with all the information they might need in one location.”

If you or someone you care for is interested in learning about the rehabilitation benefits of aquatic therapy post-stroke, or would like to learn about aquatic therapy facilities near you, visit STARRT.ca.

About the author

Anna McClellan

Anna McClellan is a Communications Specialist at Sunnybrook Health Sciences Centre. Have a question about this post? Get in touch.