What Is Expressed Through Non-Symbolic Movements in Warm Water? A Phenomenological Study of Embodied Expressivity When People Have Intellectual Disabilities and Additional Diagnoses

Introduction

Movements in water provide positive benefits for people with various disabilities, including neurological disabilities, autism spectrum disorders, and intellectual disabilities. Researchers report favorable physiological, medical, social, and cross-sectional outcomes from warm water’s effects on the body through buoyancy, pressure, temperature, and fluidity (Naumann et al. 2021). To understand the value of movements in warm water for people with moderate, severe, or profound intellectual disabilities and additional diagnoses (ID+AD), I draw on prior research that recognizes embodied communication as fully valid through the application of embodied phenomenology (D’Angelo 2020; Gallagher and Aguda 2015; Lemermeyer 2021). Applying phenomenology in warm water, I recognize the communicative potential in the moving body and contribute to methodologies that incorporate the perspectives of people with complex disabilities without relying on the verbosity of proxies.

This article builds on the phenomenological methodology of Merleau-Ponty (2014) to argue for the validity of embodied expressions when complex disabilities make symbolic language difficult to master. Merleau-Ponty values both the objective (the empirical) and the subjective (the intellectual) aspects of human existence. He asserts that movement encapsulates and conveys both dimensions to the external world. Thus, embodied phenomenology can overcome the dualistic approach that separates body and soul and challenge the emphasis on symbolic language prevalent in research on PIMD (Bredewold and van der Weele 2024, 147).

By posing the research question, ‘What is expressed through non-symbolic movements in warm water? A phenomenological study of embodied expressivity when people have intellectual disabilities and additional diagnoses’, I challenge the prevailing notion of who is considered competent enough to have their perspective included in research.

This article builds on the recent study by Gómez-Victoria et al. (2025), which questions traditional notions of rationality in disability research. They investigated how a girl with autism and her father interacted with water, each other, and a toy jellyfish. The authors collected data in a pool and challenged the conventional understanding of communication as solely verbal and auditory-vocal. They highlight how the pool and its objects can broaden our understanding of communication for non-verbal children. As Gómez-Victoria et al. (2025) and this article critique methodological limits and representation in disability research, they contribute to a methodological shift toward more inclusive disability research.

In examining the hierarchy in disability research related to water activities, Gonjo and Olstad (2021) find that Paralympic swimmers are often underrepresented compared to their non-disabled peers. Their review presupposes that Paralympic participants are competent in symbolic language, including speech or symbolic augmentative and alternative communication. While Paralympic athletes have visual or physical impairments, this epistemological demarcation is understandable, as these disabilities do not imply challenges with performing symbolic communication.

For athletes with intellectual disabilities, Olympic sports are organized through the Special Olympics. Given the communicative challenges associated with intellectual disabilities, difficulties with performing symbolic language may explain why research on intellectual disabilities and swimming (Hammond, Young and Konjarski 2014) and on the Special Olympics (Alexander-Urquhart, Bloom and Fraser 2025) often relies more on proxy information than Paralympic research does. Fiorilli et al. (2016) integrate the subjective perspectives of Special Olympics swimmers with those of their parents to investigate how participation positively affects athletes with Down syndrome. Similarly, Kim et al. (2024) include the perspectives of Special Olympic athletes, supported by their parents, during Zoom interviews—a digital tool that assumes participants can communicate symbolically or requires parents to translate participants’ expressivity.

The Structural Water Dance Intervention (SWAN) is a Swedish intervention study on water activities specifically designed for those with profound intellectual and multiple disabilities (PIMD). In evaluating the SWAN project, Matérne, Frank and Arvidsson (2021) concluded that goal attainment scaling is useful for monitoring small changes related to individual goals for adults with PIMD. They encourage future research to explore how scaling can measure the performance of people with PIMD. Matérne et al. (2022) used dialogical theory and conversation analysis to understand interactions among three adults with PIMD and their staff. They demonstrate that combining warm water and music facilitates movement, enhancing mobility and expressivity. For future studies, the authors suggest exploring various activities, objects, and participation frameworks for people with PIMD. Lundqvist et al. (2022) measured salivary cortisol levels and stress in the participants by collecting saliva in a randomized controlled crossover trial. They concluded that SWAN reduces stress in adults with PIMD, and that future research should examine larger samples in different contexts.

The SWAN project has provided insights into contextual factors that facilitate water activities from the perspective of support personnel and health staff. Granberg et al. (2024) emphasize how staff turnover, declining economic resources, unclear expectations, transportation difficulties, lack of assistive devices, and the need for programs to enhance staff competence affect bathing possibilities and experiences.

Overall, the SWAN project has provided important insights into a group previously excluded from research. However, the project’s chosen methods only partially illuminate the participants as active subjects with their own perspectives and agendas.

This article, which addresses the subjective experiences of four men with ID+AD, bypasses many of the contextual challenges described by Granberg et al. (2024). It provides insight into what happens when travel is easy, when bathing occurs regularly, and when interactions are based on subjective movements rather than pre-planned interventions.

The Purpose of This Article

This article aims to describe the lived experiences of four participants with ID+AD to challenge prevailing methodologies in disability studies. Warm water, known for its buoyancy and viscosity that support balance, its temperature which relieves muscle and joint pain, its pressure, which positively affects digestion and breathing, and its fluidity, which provides an immediate response to movement, offers a range of benefits.

Practical challenges, as described by Granberg et al. (2024), are evaded at the adult daycare center where I conducted close observations for this study. This allowed me to investigate the experiences of participants who frequently visit the pool without encountering the previously mentioned obstacles. By using the pool at least once a week, these four men and their carers know how to enter, move within, and exit the pool. The carers do not make pre-planned interventions; instead, they respond sensitively to participants’ subjective embodied outreaches. This non-interventional approach supports a wide variety of unrestrained movements among the participants.

Previous disability research has offered valuable insights into what can be expressed through symbolic communication. However, an overly rigid focus on what Merleau-Ponty (2014) would describe as intellectualistic or empirical knowledge can obscure the subjectivity of participants with ID+AD. In alignment with the United Nations (2025) goal that no one should be left behind, this article credits what can be expressed through embodiment, and as such, it underscores an ethical obligation. In this context, leaving no one behind means exploring how to include the perspectives of those whose conditions affect symbolic expressivity in disability research.

Relying too heavily on verbal proxies may reinforce the idea that expressions from people with more complex conditions are unworthy of consideration (Evensen 2023, 265–280; Skarsaune and Hanisch 2021). This risks perpetuating the notion that the perspectives of people with ID+AD are difficult to access and scientifically challenging to value. When proxies are allowed to recount the stories of others, researchers have also found discrepancies arising from their emotional involvement (Østvik, Granlund and Seim 2024).

Embodied phenomenology values diverse ways of being as fully worthy, while the phenomenology of water illuminates how relationships and solitude can co-exist, even amid complex disabilities. I argue that these two strands of phenomenology can deepen our understanding of the experiences of people with complex disabilities without relying on proxy information. Water is an environment where embodied freedom is enhanced as gravity is reduced and the use of assistive aids is minimal. Furthermore, data is collected in an institution without pre-defined interventions, allowing time and space for subjective movements to unfold.

Phenomenological Methodology

In promoting the value of the moving body, Merleau-Ponty (2014) rejects the notion that a researcher’s subjectivity can be separated from the research process and its outcomes in interpretive projects. Instead, Merleau-Ponty (2014, 100) emphasizes the significance of visible embodied subjectivity, stating: ‘If my arm is resting on the table, I will never think to say that it is next to the ashtray in the same way that the ashtray is next to the telephone’. In accessing non-symbolic life-worlds through his lens, embodied interactions serve as the researcher’s primary tool. As an embodied phenomenologist, my background and embodiment are inherently intertwined with the findings, and making my preconceptions visible is essential to ensuring a valid project.

I am a Western European female kindergarten teacher with advanced education in adapted physical activity. I hold a master’s degree in special needs education, specializing in intellectual disabilities. For my PhD, I investigated the lived experiences of children with complex, multiple disabilities. I have alternated between pedagogical work in inclusive kindergartens and schools and further education, spending the last 12 years at a specialized sports university. I was once a competitive swimmer at a high national level. Although I have retired from competitive swimming, I still cherish the freedom of movement that water provides.

As this project employs an embodied phenomenological approach, I aim to ensure phenomenological reduction by encompassing both epoché and reduction. Securing the epoché involves setting aside what is unrelated to the phenomenon of being a person with ID+AD moving in water. I have continuously focused on my methodological aim: to include non-symbolic perspectives of the four men without yielding to the temptation of gathering information through proxies. This does not mean I have refrained from speaking to significant others, such as the carers at the adult daycare center; rather, the study’s empirical foundation rests on the participants’ embodied expressivity. To attend to the reduction, I have limited my participation to activities in the pool, shower, and changing room. By framing the study through the temporality of the activity and the spatiality of the pool, I have remained close to the phenomenon of interest, securing both the reduction and epoché. Furthermore, I recognize my positive attitude toward water activities, and to ensure reduction, I remain open to the possibility that the participants’ movements in warm water may challenge my preconceptions.

The Phenomenology of Perception

To investigate the expressivity in the movements of the four men, I consider how Merleau-Ponty (1908–1961) emphasizes the intentionality of the moving body. In his seminal work, The Phenomenology of Perception (2014), he highlights the moving body and its pre-reflective sensing and reflective perceptions as central to human learning. He does this without accepting the dualistic claim that human experiences can be divided into body or mind. Instead, he argues that movements integrate body and mind, providing researchers with access to subjective perspectives. He further describes human gestures, such as wiping away a mosquito (2014, 108), as analogous, direct and fully valid carriers of meaning. From Merleau-Ponty’s perspective, movements are existentials that connect humans with different abilities, as they transcend minority categories (Merleau-Ponty 2014).

Merleau-Ponty (2014, 110–111) claims that if those who have the power to shape environments do so with normality as their guiding principle, they fail, as normality cannot be derived from what is different. He challenges normality as self-explanatory, asserting that attempting to fix a disability is a pathological phenomenon. He further describes how different bodies have various accessible instruments for engaging with the world (2014, 154). In this, he challenges the notion of normality as a standard against which all deviations must be assessed.

One premise of relying on Merleau-Ponty is to maintain modesty in how we understand other people. When people share experiences, one’s gestures enter the world of the other, shaping perceptions for both. Shared experiences become shared history, creating communicative possibilities. Merleau-Ponty (2014, 427–428) explores the importance and pitfalls of shared experiences in a parable where he stands beside his friend Paul, who points toward a tower. Maurice and Paul do not perceive the tower from the same viewpoint; rather, their perceptions are analogous from different physical positions, shaped by their unique pasts and futures. This shared experience becomes significant for them, as they are united in the moment. Sharing embodied experiences can be a fundamental breeding ground for shared perspectives, even when bodily and intellectual starting points diverge. However, complete understanding of the other remains a utopia.

Results and Discussion

Despite previous research’s call for interventions, it is evident that physical activity, as defined by the World Health Organization (WHO 2024) as ‘any bodily movement produced by skeletal muscles that requires energy expenditure’, occurs when the four men enter the warm water. Alongside physical activity, expressive moments—ranging from small gestures to more extensive movements—serve as human existentials that constantly manifest in the pool as forms of possible communication.

As I describe a hug, the end of a gentle swing, a ball throw, relative proximity, the squeezing of puffed cheeks, and tidying up, the first six anecdotes describe the embodied expressivity of the four men. Furthermore, the three last anecdotes illuminate learning as a two-way process as I recount the stories of a high-five, the jump of a frog, and the rhythm of tiles and seams.

Warm water, combined with the absence of interventions and assistive devices, creates opportunities for you to choose to be close to others:

You leave your wheeled walker in the changing room and walk to the pool supported by your carer Maren. Upon reaching the pool, you climb down the ladder into the water by yourself, holding onto the handrails. From there, you move along the pool’s edge with your chest toward the tiles until you reach the deepest part. Then you walk toward Maren and place your chin in the hollow of her neck for a long-lasting hug.

Without the wheeled walker and supported by the buoyancy of water, you can seek out Maren and give her a hug, which serves an analog embodied expression for you want for hugging. Maren’s sensitive response highlights the potential in warm water as an environment that facilitates care on your terms. For people using assistive devices such as standing frames, wheelchairs, or wheeled walkers, water can, in some cases, compensate for the support these devices provide on land. In this way, water creates opportunities for embodied closeness without an interposing device between bodies and environments.

Water gives you the freedom to seek out embodied closeness, but also to seek out solitude. Your possibility to alternate between intimacy and distance depends on Maren’s willingness for close, embodied contact, and her respect for your choice when you move away:

You have a preferred playlist. Toward the end, a sound theme from Drop Mania (ShardServal 2016) plays (listen to the sound theme from 9: 10). You walk to Maren and lie down in her arms. She supports you and gently leads you back and forth through the water while you remain still. When the song ends, you rise and grab a floating toy shaped like a frog. You hold on to it and walk to the other end of the pool. There, you release the frog, turn around, and walk back to Maren.

The intimacy, vulnerability, and trust you show Maren when you lie down in her arms are traits not everyone can accept and express as she does. Similarly, the autonomy you demonstrate through your temporary refusal of embodied closeness—rising from her gentle swing and walk away with a floating frog—is acknowledged by her letting you go and accepting you when you return. Within your free movements lie a broad spectrum of autonomy and dependency, individualism and community, care and self-sufficiency. What can be considered as water’s ‘is-ness’ and ‘not-ness’ are evident, as watery hallmarks underscore the attitude of care that unfolds in the hug and the return as well as the solitude that arises when you grab a frog and move away.

Embodied expressivity in a space shared with no one is merely that—embodied expressivity. However, when embodied expressivity reaches sensitive others who detect and act upon these expressions, communication unfolds. When you direct your hand holding a ball toward me, no words are needed for me to assume you want to throw it. When you direct your empty hand with bent fingers toward me, I understand that you want to catch. When you turn your back and dive underwater, I recognize that we are done:

I stand about two meters away from you as you direct your hand holding a small blue rubber ball toward me. I raise my hand; you throw the ball; I catch it, holding it up for you. You raise your hand with bent fingers towards me. We toss the ball back and forth until you turn away and dive underwater.

You toss the ball. I toss it back, and as you continue throwing it to me, I realize you want to keep playing. Suddenly, you turn away and dive underwater, and I understand that we are done. Your embodied expressivity is clear through how you orient toward and away from me, and in the light of embodied phenomenology, that is a type of communication that is valid and worthy of recognition.

One of you have severe- and one of you have profound intellectual disabilities. Both of you have infantile autism. Social interactions are among your challenges, yet your actions and your position toward the other express your limits for acceptable closeness:

You stand beside each other, one in the corner of the pool and one beside the outflow, with about a meter and a half between. You, standing in the corner vocalize ‘iiiii-ooooo-iiiii-ooooo’, while you, standing by the outflow create a rising and sinking melody through firm lips.

Within a non-interventional approach, your capabilities for being close to another shine through how you position yourselves. With only water between you, you are alone together or together alone. Relating to others—whether standing in the relative proximity of another or by initiating embodied interplay—is an intrinsic part of being human. The freedom to keep distance or to enter relationships on your own terms are two sides of the same story:

You and Maren face each other. You touch Maren’s cheeks with your fingers and hold them there for a considerable time. Maren waits; you both stand still. Until… Maren puffs her cheeks. You watch her, hold for a few seconds, and then you squeeze her cheeks inwards, and she blows out with a giant snort. You both laugh heartily.

An embodied initiative arises when you touch Maren’s cheeks with your fingers. Her response and your subsequent interplay create a communicative flow that culminates in a shared moment of laughter. For such playfulness to emerge, you must be close enough to initiate this moment of shared, joyful play.

Non-interventional approaches do not imply that there are no frames around what happens, as routines support movements and interactions. Not only do you accept that carer Haroon says your time is up, but you also approach carer Miriam for help tidying up the pool. When there are no objects left, you leave the pool peacefully. You bathe once a week and seem to know what to expect:

‘Time is up,’ Haroon says, ‘bathing is over.’ You search for a small yellow ball that you give to Miriam, who is on the shore. Next, you find a small red ball, a yellow spiky ball, a green sinking toy, and finally the big blue bathing ring. Miriam thanks you for each object you hand to her. When the water is clear of objects, you cross the pool slowly, climb the ladder, and shuffle into the shower.

Even if your embodied expressions indicate that you have enjoyed your time in the water, you accept that time is up when 30 min have passed. You hand the toys to Miriam, receiving her acknowledging ‘thank you’ at each meeting point. As you tidy up, the end of the session becomes visualized, and you conclude it by shuffling calmly into the shower.

Due to the non-interventional approach in the pool, learning becomes a two-way process in which participants and sensitive carers appear intertwined. The next three anecdotes illuminate how the four men meet an approach that invites their significant others into further interactions.

This anecdote demonstrates how you show your carer, John, that you would like a high-five after you have completed a task he assigned to you:

You look at John who grabs a green sinking ring and throws it where the water is about one meter deep. ‘Can you pick it up?’ John asks, and you lay down on your stomach. You float well, keeping your ears above the waterline while trying unsuccessfully to grab the ring with your hands. Suddenly, you take off and dive down; once, twice, no breathing in between. Third time, you get hold of the ring. You give it to John. Then you tap his arm with two fingers and the two of you exchange a high-five.

John provides you with a task without any guidelines on how to solve it, and you try out different solutions to succeed. Upon succeeding, you are the one who shows John that you desire a response. You contribute with the understanding that you might ask for the response by a modest gesture if he does not provide it on his own initiative.

Being free from pre-defined expectations about how to move illuminates Merleau-Ponty’s assertion that normality cannot be derived from what is different. Interventions aimed at specific goals for physical activity can reduce people with ID+AD to mere executors, resulting in the loss of the subjective resources present in free movements. Rather than applying expectations derived from statistical norms of normality, seeking support with Merleau-Ponty invites us to learn from the participants as bodies of difference. In the daycare center, carers recognize the participants’ movements as essential to situations that can and will unfold in due time. Actually, movements can be residing in something as ordinary a pair of green non-slip socks:

Not every occurrence can be planned for. Usually, you wear pink bath shoes, but today, they are damaged, so you wear a pair of green non-slip socks instead. A modest change in footwear, yet it serves as an accelerator for movement. ‘I am a frog,’ you declare. Frogs can jump, and so you do. Your legs are thin, your toes are displaced, and your knees point inward, but, boy, you can jump like a frog in the water.

You wear socks for protection, and their green color inspires you to jump, creating splashes in the water. A phenomenological approach involves confidence that such situations will develop, offering not only the objective benefits of physical activity, but also the expressivity that arises from you as a moving subject.

When you move in ways that are uncommon to me, I become intrigued to understand the sensations you seek out. When I follow your movements, you reveal how I can try to perceive your world, thus expanding my own perspective. Acknowledging your movements as valid expressions of your likes and dislikes offers a wealth of information. I have spent much time in pools, but I have never considered the contrast between tiles and seams that arise through movement:

You walk slowly three full rounds in the water along the edges of the pool with your left shoulder, arm and hip close to the edge. When you finish walking, you stand with your back against the wall, bend your knees and stretch your arms to the sides, leading them upward and downward along the tiles.

Wanting to sense what you sense, I follow your movements on the opposite side of the pool. The sensations of the sleek tiles and uneven seams create a predictable rhythm, and the contrast between sleek and uneven is distinct in relation to my body.

Knowing that your experience will never be my experience due to our different positions, pasts and futures, this moment offered me a glimpse into your perception of the world. I may never know if you experienced this as a shared moment; however, I understand that our perceptions are shaped by our distinct physical positions and unique histories. I am grateful for the way you showed me a new way to sense the world, broadening my preconceptions of what a pool can provide.

Conclusion

This article demonstrates that embodied phenomenology is a promising methodology for incorporating the subjective perspectives of people with disabilities so complex that they hinder symbolic communication. This approach enhances the knowledge conveyed when proxies, whether emotionally or professionally related to the person, share their experiences of an experiencing other.

The knowledge of practitioners is essential for researchers aiming to enter this field. By learning from their hands-on experience, researchers can investigate complex disabilities from a first-person perspective. This study illuminates how the movements of people with ID+AD can be facilitated, detected, and responded to by sensitive significant others when no interventions are employed. In doing so, the benefits of physical activity are merged with an acknowledgment of the subjectivity of the participants, informing future researchers who seek to avoid the objectification of movement experiences.

I highlight the potential of open-ended activities that promote movement, expressivity, and communication, alongside physical activity, for persons with ID+AD when supported by sensitive others. Drawing on phenomenologists such as Merleau-Ponty (2014), Bachelard (2006), and Neimanis (2017), this article explores how subjective movements convey human preferences. While prior research on movement in water has emphasized the necessity of interventions for people with complex disabilities, this project challenges that notion. Recognizing movement as a phenomenon that unfolds when there is alignment between the person and the environment can inform how professionals facilitate future water activities.

This article’s emphasis on movement as a form of expressivity demonstrates how critically examining prevailing methodologies can enhance inclusivity in disability research. Methodologies that incorporate the perspectives of people communicating non-symbolically, without relying on translations from others, align with the United Nations Sustainable Development Goals, which assert that ‘Leaving No One Behind’ is a central principle for 2030.

Previous research exploring the perspectives of people with complex disabilities has often depended on proxies to convey their insights. While these studies have provided valuable information, such methodologies risk reinforcing the misconception that people with complex conditions cannot contribute to valid insights to research. I argue that disability research must expand its epistemological boundaries to include the subjectivity of people with ID+AD without the filter and verbosity of proxies. This does not suggest that I, as the researcher, am free from bias or that I have nothing to learn from proxies. However, while I gain insight from how staff interact with the participants, I do not rely on their interpretations or elaborations to represent the participants’ perspectives.

Recognizing movements as a form of expressivity signifies a methodological shift toward a more inclusive disability research and serves an epistemological statement that challenges conventional notions of valid truth. This project demonstrates how people with ID+AD can be included without relying on positivistic methods and measures that may overlook their contributions due to their divergence from statistical norms. Importantly, a phenomenological focus on lived experiences must not naïvely overlook the realities faced by people living with ID+AD, including their vulnerability and need for care. Vivid descriptions of behavioral and physical expressions must be handled with care to balance respect and honesty. Researchers who apply Merleau-Ponty’s understanding of normality recognize that each person is a unique scale, and that striving for statistical normality is an imprecise way to address differences. However, living in a shared world necessitates that we confront both successes and shortcomings.

Surviving without sharing a world with others is particularly challenging for people with ID+AD, who embody vulnerability and require care. This project is set in a context where correspondences between the participants and their time, space, objects, and others are pronounced. To provide a nuanced understanding of the lived experiences of people with ID+AD, I encourage future researchers to conduct embodied phenomenology in contexts where the interplay between subjects and the world is not as fluid as presented in this article.

Artificial Intelligence

The submission complies with the publisher’s guidelines on the use of artificial intelligence (AI). The AI-tool GPT UiO 40-mini has been used for language proofing the text. Every suggestion made by the tool is assessed by the author to keep true to the article’s phenomenological point of departure.

Competing Interests

The author has no competing interests to declare.

Author Contributions

This work is conducted by the author alone.