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Early Intervention Speech Therapy

Interview: Aquatic Therapist Susan B. Nachimson, MA, CCC-SLP, CMT - Part 1

Published January 15, 2009 5:37 PM by Stephanie Bruno-Dowling
I have had the absolute pleasure of speaking with and interviewing Susan B. Nachimson (pronounced /nakumson/). Susan has been practicing speech therapy for over 30 years in many different arenas and venues. Susan is trained in both NDT (Neuro-Developmental Treatment) and WATSU (Water Shiatsu). She is also a certified massage therapist and implements aquatic therapy with speech clients frequently in practice.

Susan's experiences both in the field of speech-language pathology and beyond, I'm sure, will delight and amaze you! Enjoy reading below as we embark upon Susan's professional journey from a young professional to a multi-dimensional therapist.

: Susan, tell us about your background and when you first started practicing as an SLP.

Susan: I began practicing in this profession in August 1976 in public schools after having received an MA Degree in Speech Pathology at Humboldt State University, Arcata, California. I received a BA from Valley State College, now California State University, Northridge (CSUN), 1965. I spent those between years raising children and taking a graduate course here and there until I finally found myself in a great position to complete the teaching credential I began in the '60s and acquired an MA in the same year.  My children were in elementary school by now and every time I volunteered as a parent I was enticed into screening students with speech and language issues who were not being served in the years before public law demanded identification, assessment and treatment for our students.

Stephanie: How did you become interested in furthering your certifications and getting NDT trained, as well as becoming a certified massage therapist?

Susan: After years of working within the ASHA model and following recommendations and strategies picked up from specialized continuing education courses, state and national speech pathology conventions and multitudes of purchased textbooks and manuals, I was asked to work with a two-year-old child with cerebral palsy. Her mother asked, ‘Are you an NDT Therapist?' ‘No', I said. ‘Do you know what that is?' she asked. ‘No,' I said again. ‘Are you interested in learning?' the mom then asked. ‘Sure,' I said. 

That was the beginning of a shift in this profession for me that was very interesting, profound, and exciting.

After this, I was led to a colleague who taught NDT (Neurodevelopmental Treatment, aka Bobaths) strategies for speech pathologists and my hands-on education began. I had already enrolled in a massage therapy licensing course. I had a patient, post CVA, with oral apraxia of speech and severe limitations in breath support who appeared to benefit from a hands-on approach. 

By this time I had taken some courses in Transpersonal Psychology that emphasized issues in the body that were affected by breath-holding incidents secondary to trauma. Stroke, CP, seizures were all conditions that resulted from trauma. It was simple to put the concepts together from a psychological approach to a functional speech pathology approach. I was aware that touch needed to be brought into my practice. As a certified massage therapist (CMT) I was licensed to practice hands-on chest compression to facilitate deeper and fuller breath control for my patients. So, now, I was enrolled in massage therapy and learning NDT simultaneously hoping I was heading in a positive direction!

Stephanie: Well, we know now that you definitely were! You have so many skills! So, now, tell us what led you to doing aquatic speech therapy?

Susan: In 1986, after my last child graduated from high school, I prepared to take an 8-week pediatric NDT course in order to enable me to work with young children with a variety of multiple disorders with feeding, speech and language needs. I was fortunate to have an opportunity to work at Easter Seals in San Francisco as a temporary replacement for a colleague on maternity leave. It was there that I saw many under 3-year-olds in both the clinic and home-care settings. 

The child who led me into water was two-and-a-half years old. He crawled with a stiff body, had severe laryngeal blocking and was frequently very angry. It occurred to me that maybe we were not a good match after frequently being hit by him.

Finally, one day, I asked his mother, ‘How is this little guy in his bath?  Does he enjoy the water?' It is so amazing when the perfectly correct moment occurs.  His mom responded, "He LOVES his bath—he laughs and splashes all the time!" 

I heard ‘laugh' and was inspired! I started to discuss working in water.  The rest is history! This sweet boy locked into his body, traumatized by limited breath support and poor muscle development, became independent in water.  His warm-up time on the ramp was seconds as he crawled into the water.  Mom trusted me to do the right thing.

My personal experience was teaching all of my own children and nieces and nephews and friends' children to swim for fun. In addition, I learned in transpersonal psychology workshops about a prenatal journey in water that is a tool used to help people unlock deeply rooted traumas.

This little guy just went under and used all-fours to swim towards his mom, pulling his head straight out of the water and laughing a clear, open belly laugh with no traces of laryngeal blocking or limited inhalation!  It was absolutely AWESOME to say the least.  

I wasn't sure how to interpret the session per goals and objectives, but I knew we addressed increasing respiration for phonation!  The most remarkable awareness was how independent and functional this child was in water in contrast to totally disabled on land. I knew there needed to be a transition from water to land.  Unfortunately, there were no follow through sessions with this child, but many new sessions with other children were tried with new strategies being developed with each one and hence began my love for aquatic therapy!

Today, my favorite place to practice in my field is when providing diagnostic therapy in a warm water setting, preferably in a shallow swimming pool or spa that is at least 93F!

Thank you so much for reading the first half of my interview with the dynamic aquatic speech therapist, Susan B. Nachimson. Please join us Tuesday for the second half of our interview, when Susan will explain her recommendations for successful aquatic therapy as well as where you can find Susan now!


More information about the upcoming class. Aquatic Therapy for the Speech Therapist (details at:

e have an 18 hour class coming up at Aquatic Therapy University in Minneapolis, MN - May 14-15, 2010.

The class is being taught by 2 SLPs and 1 PT and should be an incredible opportunity to connect with other SLPs working in water.

If you are interested in coming, we have a great on-site deal with Staybridge Suites. Free meals, free transportation, inexpensive great quality suites ($74-$94/night). Once you get to Minneapolis, everything but the hotel suite is included. And, if you bring more than 1 person, we will give you each $100 discount off the registration. Share a 2 person suite and your discount will pay for the hotel.

Could you help us spread the word?

Andrea Salzman, Director of Programming

Aquatic Therapy University (from the Aquatic Resources Network)

3500 Vicksburg Lane N #250

Plymouth, MN 55447 USA

(800) 680-8624

Aquatic Therapy for the Speech Therapist:

Taking Language & Speech Development into Water


18 hr. training module packed into 2 days (4 hr. Boot Camp plus 14 hr. main course). Designed for the SLP or speech therapist, this course includes information on working with both children and adults in water for language and speech development. Provides tips on positioning patients in water for speech therapy, oral-motor tasks, sensory integration, use of aquatic equipment, and progressions for improving breath control, vocalization and other speech-only goals. Shows tips for taking augmentative communication into water. Discusses why the pool is an amazingly appropriate tool for the speech therapist in many circumstances. Includes interactive forum on hot topics for the SLP working in water.


Andrea “Dre” Kane, CCC-SLP graduated from the University of Wisconsin-River Falls in 2003 with a Masters in Communication Disorders. Following graduation, Dre worked with adults in a work rehabilitation setting in Eagan, Minnesota. Dre has training in feeding issues (specifically the SOS approach to feeding) and PROMPT.  In 2007, she began working in the pool at Special Children Center, in Hudson, Wisconsin, alongside Kathleen “Kiki” Dickinson, MPT who has over 15 years of experience developing and implementing aquatic therapy programs. Kiki is certified in the Universal Exercise Unit/Therasuit Method and Craniosacral Therapy. Kiki has been an adjunct professor at St. Catherine’s University for 10+yrs.

Reesa Salomon, M.S., CCC-SLP graduated from Emerson College in 2001 with a Masters in Communication Sciences and Disorders.  She currently works at Cerebral Palsy of North Jersey’s Horizon School in Livingston, New Jersey and provides speech and language therapy to children aged 0-3 in the Early Intervention Program.  Reesa has a great deal of experience in feeding and swallowing difficulties and is PROMPT trained.  She works with many non-verbal students, utilizing a variety of low and high technology augmentative and alternative communication systems. She treats children in the aquatic therapy pool at Horizon School.


1. Participate in an open forum discussion on the emergence of the therapy pool as a viable treatment venue for the SLP (forum)

2. Make a 3 minute verbal “case” for providing speech therapy services in the water.

3. Locate and describe what ASHA, state laws, and payers have to say (if anything) about SLPs working in water (lecture)

4. Recite 5-6 aquatic precautions and contraindications specific to the speech patient (lecture).

5. Outline 1-2 ways to divide labor and schedule pool-time when all three disciplines are involved in a patient’s care. Describe 1-2 ways that the goals of water-based OT, PT, and speech should differ (lecture)

6. Determine under what conditions an adult should be considered for aquatic speech therapy (lecture)

7. Craft a sample home program for parents/caregivers who wish to incorporate 3-4 speech-related tasks in the shower, bathtub or community pool. Be able to share with parents where they can obtain additional training materials (lecture)

8. Describe why aquatic therapy may be the treatment of choice if (a) the patient has poor respiratory support and control for speech, (b) the patient is difficult to position for therapy; or (d) the patient is unwilling or unable to vocalize on land (lecture)

9. Demonstrate 2-3 effective positions to work with adult and pediatric clients in the water (lab)

10. Perform 3-4 aquatic therapeutic movements, tasks, or exercises designed to:


     increase attention to a task (a foundation for building strong language skills)


     increase strength of speech-related musculature


     improve ROM of chest and shoulder region


     improve head and trunk righting as a precursor for speech


     perform lip and mouth closure


     improve total communication


     improve verbalization, articulation, descriptive language and sentence richness


     encourage play and social interaction (lab)

11. Demonstrate 1-2 aquatic tasks or activities from each of the following specialty techniques (as each relates to the speech patient):


     Aquatic Sensory Integration (ASI)


     Aquatic manual therapy and stretching


     Oral Motor exercises


     Augmented communication


     Watsu (lab)

12. With a partner, design and implement a 15-minute aquatic treatment plan (including equipment selection) for 1-2 of the following:


     Non-progressive neurological disorder (e.g. cerebral palsy, CVA, TBI)


     Progressive neurological disorder (e.g. Parkinson’s, multiple sclerosis)


     Pervasive developmental disorder (e.g. autism)

March 15, 2010 1:03 AM

Very interesting.   I will be sure to read the second part of the blog.   Working with OTs who are so sensory oriented has re-opened my eyes to and ears as I approach my pediatric clients.


March 5, 2010 11:34 AM

To those interested in this topic, Susan Nachimson, SLP will be teaching the class "Aquatic Therapy for the Speech Therapist: Talking Speech and Language Development into the Water" at Aquatic Therapy University ( May 14-15, 2010 in Minneapolis, MN.

Details at:


A 4-hr ATU Bootcamp is offered at no additional cost immediately prior to this class (see next column for schedule). This class is required before taking any ATU course (current water-gurus excepted).


A 18 hr. training module packed into 2 days (4 hr. Boot Camp plus 14 hr. main course). Designed by and for the SLP or speech therapist, this course includes information on working with both children and adults in water for language and speech development. Provides tips on positioning patients in water for speech therapy, use of aquatic equipment to maximize results, and progressions for improving breath control, vocalization and other speech-only goals. Discusses which aquatic specialty techniques (e.g. Watsu®, Ai Chi) may be usable by the speech therapist. Includes information on current research supporting performing speech tasks in the pool. Addresses why a therapy pool is an appropriate tool for the speech therapist and makes a case for including 97113 as a reimbursable code for SLPs.

Andrea Salzman December 20, 2009 11:16 PM


I was interested in reading the first half of the interview with Susan Nachimson and look forward to the second half. I wonder if readers would be interested in reading the article I wrote with Emilie Leeks 'Making Waves - Communication and Swimming'. This article was written for the Communication Matters Journal following a presentation at the Communication Matters National Symposium, University of Leicester, September 2006 and can now be found on the Halliwick AST website at in the section 'Newsletters and Articles'

Ann Gresswell (Senior Lecturer - International Halliwick Association (IHA))

Ann Gresswell January 23, 2009 12:01 PM
Oxford UK

To Mr. Kheir ~

It appears you may have received a link to our blog in error. For furture reference - this is a blog/website for speech therapists and parents of children with speech and language delays/disorders. Good luck in your search.

Stephanie Bruno Dowling

Blog Author

stephanie January 19, 2009 7:13 PM
United States

I do appreciate your effort in alert.....

My alert was NDT by that I ment Nondestracive testing. What is shown here above was about Neurodevelopmental Treatment.

Though I really appreciate the ability of Susan B. Nachimson, that was not I am looking for.

Hassan Kheir, welding - Instructor, Mechanical January 17, 2009 4:52 AM

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About this Blog

    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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