Effect of Aquatic Therapy Program on Balance in Children With Spastic Diplegic Cerebral Palsy

Cerebral palsy (CP) is the most common cause of permanent motor disability in childhood, with spastic diplegia being the most prevalent subtype, characterized by bilateral lower limb spasticity, impaired postural control, and significantly compromised balance - deficits that restrict functional mobility and participation in daily activities. These balance impairments arise from disrupted selective motor control, abnormal muscle tone, reduced proprioceptive integration, and impaired neuromuscular coordination, and represent a central therapeutic target in paediatric rehabilitation. Aquatic therapy exploits the physical properties of water - buoyancy, hydrostatic pressure, warmth, and viscosity - to reduce spasticity, facilitate movement, and promote motor learning in a safe environment, with meta-analytic evidence confirming significant improvements in gross motor function compared to land-based approaches. However, studies specifically targeting balance as a primary outcome in children with spastic diplegic CP remain limited, representing a clinically important gap that this study seeks to address.

Inclusion criteria

• Confirmed diagnosis of spastic diplegic cerebral palsy by a paediatric neurologist or developmental paediatrician
• Age between 5 and 12 years
• Classified at GMFCS levels I-III
• Bilateral lower limb spasticity with a Modified Ashworth Scale (MAS) score of ≥ 1

Exclusion criteria

• Athetoid, ataxic, or mixed-type cerebral palsy
• GMFCS levels IV or V (non-ambulatory children)
• Uncontrolled seizure disorder or epilepsy not managed by medication
• Open wounds, skin infections, or active dermatological conditions contraindicating water immersion
• Fear of water (aquaphobia) or inability to tolerate the aquatic environment