Al Kovach Jr. was in a buoyant mood when he dived to nearly 100 feet in the blue waters of Grand Cayman, but he hadn't expected to feel something. Another scuba diver, Cody Unser, also had some unusual sensations, but she wasn't surprised.

The two deep sea swimmers were among a group of paralyzed patients who took part in a pilot medical study to determine whether the zero gravity undersea environment had therapeutic value for improving their physical or mental health. The tests showed unexpected positive results that have surprised researchers and generated hope of a new pathway to recovery for people with disabilities.

"I was floored like everybody else when the results came in," said Kovach, one of 10 paralyzed veterans who underwent extensive testing of spasticity, motor control and post-traumatic stress disorder during a four-day scuba certification trip in September 2011.

For Unser, who has been paralyzed from the chest down since contracting transverse myelitis at age 12, the news was a redemption. The scientific expedition was funded mostly by her First Step Foundation's quality-of-life program, and she helped motivate the physicians to don wetsuits and investigate why she feels tingling sensations when she goes on deep underwater ventures.

"I was experiencing weird things, so I brought the doctors on board," said Unser, who now is 25 and an avid proponent of the benefits of scuba diving in removing barriers for people with disabilities. "The study results were really outside the box and has put adaptive scuba diving on the map."

Improved spasticity

Daniel Becker, MD, one of two physicians who conducted the research, said positive results lasted three to four weeks and included an average 15% drop in muscle spasticity, a 10% rise in sensitivity to light touch and a 5% increase in the ability to feel a pinprick. In some cases, body tone, sensation and motor function improved as much as 20% to 30%. In five veterans who suffered from post-traumatic stress disorder, symptoms dropped by 80%, while for the overall group, symptoms of obsessive-compulsive disorder and depression fell 15%. In contrast, a matched group of able-bodied divers showed no changes on any of the array of tests.

Becker, head of pediatric restoration therapy at the International Center for Spinal Cord Injury at Kennedy Krieger Institute, Baltimore, called the results unprecedented. He's pushing for sponsors to fund an expanded $250,000 scuba study that would add spinal fluid and blood extraction to possibly find the causes of the improvements.

"Within 13 months, I'm quite confident we would have significant and exciting results," said Becker, whose co-researcher on the Cayman trip was Adam Kaplin, MD, an assistant professor of psychiatry and neurology at Johns Hopkins' School of Medicine.

Kaplin said the research could lead to new therapies that would improve function and quality of life for people who have been paralyzed by physical trauma or disease.

Kovach, senior vice president of the Paralyzed Veterans of America and a former Navy SEAL who has been paralyzed for nearly two decades, said if the study opens a new pathway to recovery, it should be pursued along with stem cell therapy and other promising research. "I want the doctors to find a cure, and if they need volunteers to expand the study, I'll be the first to raise my hand and say I'd do it again," he said.

Magical kingdom

Unser, founder of the Albuquerque-based First Step Foundation, and daughter of Indianapolis 500 winner Al Unser Jr., decided to take up scuba diving for its therapeutic qualities. "What happens in the ocean is magical," said Unser, who is in the graduate program for public health at George Washington University in Washington, D.C. "When I took my first dive, I knew instantly this was something I wanted to share with others."

The foundation has a team of qualified diving buddies and guides who accompany people with various disabilities on open-water dives and undersea adventures that has opened up a new world in zero gravity space, Unser said.

Denise Dowd, OT, was in college when she became a scuba instructor and went to Hawaii on the fledgling Handicapped Scuba Association's first warm water trip in 1985. "We were in Hawaii teaching diving to wheelchair tennis players in between their tournament," Dowd said. "What a great experience for an OT student. These guys were unstoppable, not letting their disabilities get in their way. This gave me a great foundation for working in rehabilitation and seeing people's potential beyond the doors of rehab."

Dowd graduated as an OT from San Jose (Calif.) State University later that year and in 1986 became the 10th scuba teacher to get certified with the HSA. She's since taught hundreds of people with disabilities to scuba dive and conducts a four-day course to train instructors about types of disabilities and how to teach and relate to adaptive diving students.

"They also get to experience what it would be like to have paraplegia, quadriplegia or blindness and scuba dive," Dowd said. "I love this course, it allows me to use my skills as an OT to teach others how to work with people with disabilities."

Dowd teaches an introduction to scuba program at Cottage Rehabilitation Hospital in Santa Barbara, Calif., where she's an OT supervisor and has diving activity incorporated in a wheelchair sports camp and a one day mini-sports clinic called Hot on Life. Her full scuba courses are taught at a dive shop.

Reduced edema

Dowd said scuba diving is a sport that allows people with disabilities to leave their stresses — and wheelchairs — behind. "Not only is it a calm and serene environment underwater, there are physiological effects that slow our heart rate down to help us to relax," said Dowd, who has observed therapeutic values of diving for relieving pain and improving body tone and spasticity.

Benefits also come from reduced edema in the extremities because of immersion diuresis, a phenomenon that causes blood vessels to constrict when submerged in water colder than the air, Dowd said. The vasoconstriction occurs primarily in the skin and superficial tissues and in arm and leg muscles, sending an increased volume of blood to the heart, lungs and other central organs.

Reduced edema may help enable the increased range of motion and strength that divers with disabilities experience in a gravity-free environment, Dowd said. "Many divers become aware of movement they did not know they had until they got in the water," she said. "Once they gain awareness that this movement exists, they are able to work on strengthening those muscles and using them more functionally."

Scuba for soldiers

Harvey Naranjo, OTA/L, adaptive sports coordinator for Soldiers Undertaking Disabled Scuba at Walter Reed National Military Medical Center in Bethesda, Md., said scuba diving is a popular therapeutic choice for injured service members returning from Iraq and Afghanistan.

The year-round scuba program that begins at the hospital swimming pool and ends with open water diving is proving beneficial for soldiers with severe disabilities and handicaps, said Naranjo, a civilian and native New Yorker who spent seven years as a Coney Island lifeguard and did a tour of active duty as an Army OT.

"Once they're in the water and safe, it equalizes the playing field as long as they have the right type of equipment and modified technique to do it safely and with a diving buddy," Naranjo said.

He said the weightless underwater environment lets patients move naturally and helps control phantom pain that occurs with lost limbs or paralysis. The therapy also challenges participants to use dormant muscles and work on getting tone and function that previously was absent.

Once the pool instruction is over, the participants have six months to make four open water dives to become certified, and SUDS takes them to warm destinations in the Caribbean, Virgin Islands, Florida Keys, Curacao and Guantanamo Bay for the underwater trials.

"I get to see empowerment first hand," Naranjo said. "These are young people who defended our country and want to be active. They don't want to stay home in a wheelchair the rest of their lives." •

John Leighty is a freelance writer.