That is, communication must be determined based on the different dimensions that surround this concept, which include, among others, the ability of the disabled individual to communicate through speech and nonverbal communication, as well as understand communication from other people, or as the message is being transmitted to him/her. When the dependent variable is clearly determined and defined-that is, effectively operationalized-the authors will be able to state the generalizability of the results of the study in terms of communication, and specifically in the context of the participants' experiences as individuals with either learning or physical disabilities.
2) While communication is just one facet of the variable engagement level, engagement level as a dependent variable was also not clearly stated in the article. In this particular variable, the measures through which communication was identified as such was not only restrictive, but are also limited or few in scope. Identifying engagement level of the self in terms only of rocking and hand-flicking are simple measures that do not cover the entirety of the measure, 'engagement level in terms of the self.' The article left the reader wondering whether the engagement levels were only identified in the terms reported by the authors, or whether there are other measures that they used to quantify engagement levels, and in effect, establish the quantitative relationship between engagement levels and response vis--vis the participant's immersion to hydrotherapeutic environment. In effect, what this observation demonstrates is that engagement level does not translated to communication only, but also an understanding of the activity and corresponding physical action that the individual has given in response to a specific communication prompt.
3) The article reported an increase in the engagement levels of the participants once they have been immersed or exposed to the hydrotherapeutic environment. Although there has been an increase in the engagement levels, three contentions to these findings can be observed. The first contention is that the reported increase in engagement levels are not reliable because of the questionable operationalization of the variables used for the study. Secondly, the study did not also report whether these increase in engagement levels are significant relationships or not. This is a crucial point that must be established in the article, since the increase in engagement levels of the participants will cease to be relevant and important if the reported percentages and increases are not significant in relation to the participants' immersion to the hydrotherapeutic environment. In effect, because the relationship established in the article were not clarified as whether significant or not, the effect and influence of the independent variable from the dependent variables loses its importance, rendering the study and its findings insignificant for the readers.
4) The design of the research study itself should have used a time-series experimental design, comparing the participants' performance during and after the time they have been exposed