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The purpose of this case series is to describe the implementation of an aquatic physical therapy (PT) program at a pediatric hospital and to document improvements in participants’ abilities after PT intervention.Four patients with cerebral palsy, juvenile idiopathic arthritis, or Prader-Willi syndrome participated in aquatic and land-based PT intervention. Three of the patients had orthopedic conditions which required limited weight-bearing or low-joint impact during motor activities. A wide range of outcomes were used to assess changes in participation, activity, and body function. When available, minimal detectable change and minimal important difference values were used to interpret data.Clinically significant improvements were documented in functional mobility, walking endurance, range of motion, muscle strength, and/or pain reduction for all 4 patients.Aquatic PT used as an adjunct to land-based PT interventions may be effective in improving outcomes in patients with physical disabilities.