Regaining Balance, Coordination and Confidence Through Aquatic Therapy After Brain Tumor Resection
Functional recovery following brain tumor resection is a prolonged process characterized by a range of physical, emotional, and psychological changes. In spite of a successful tumor removal, patients often experience persistent challenges such as generalized or muscular weakness, impaired balance, coordination deficits, and gait disturbances. Rehabilitation aims to address these symptoms, thereby promoting greater independence, confidence, and quality of life. Due to its unique properties, aquatic therapy is recognised as an effective and patient-centered intervention for individuals with neurological conditions.
This case involves a 59-year-old female who underwent tumor resection ( Frontal lobe craniotomy) in October 2025 following a diagnosis of left parasagittal meningioma over the motor and sensory strip invading the sagittal sinus in August 2025. Postoperatively, the patient developed right-sided weakness and gait difficulties. She demonstrated a favorable prognosis after participating in an intensive rehabilitation program. Based on the current evaluation, certain persistent impairments were evident, including muscle weakness, impaired joint position sense, balance and coordination deficits, gait disturbances, reduced stability, and decreased confidence in ambulation. Aquatic therapy was incorporated to address these challenges during daily activities. The patient completed a three-week structured rehabilitation program at Aquacentric Therapy, Prabhadevi, consisting of 20 aquatic sessions and 10 land-based sessions. Aquacentric Therapy is Asia’s first aqua physiotherapy centre in Mumbai with 3 branches(Prabhadevi , Andheri and Bandra) offering neurological rehabilitation and recovery programmes . The physical properties of water, such as buoyancy and hydrostatic pressure, facilitate movement by reducing joint load, while viscosity and hydrostatic pressure provide resistance, thereby enhancing strength and proprioception. Utilizing water viscosity as a resistance medium, aquatic therapy offers effective resistance training as limb movements generate drag forces. Repetitive sensory input from water resistance increases body awareness and movement perception, improving joint position sense.
Furthermore, the multidirectional resistance and turbulence of water continuously challenge postural adjustments, thereby facilitating balance reactions, coordination, and motor control.
Lower limbs and core strengthening, proprioception, balance, coordination, and gait training were a part of structured rehabilitation. In the initial sessions, pool noodles were used for lower-body strength training with support. In the further sessions, these exercises were performed, refraining from support. Kickboards and other aquatic equipment were utilized for strengthening the core muscles. Initially, these exercises were performed with wall assistance before weaning off. Single-leg standing, tandem standing, and a combined treatment that focused on strengthening and balance with pool noodle exercises for lower limbs were used to address balance. To improve lower limb strength, core strength, balance, and proprioception, single-leg standing with spine rotation and single-leg standing with upper body exercises were carried out. Dual task activities such as walking and catching/throwing the ball , walking while retrieving beads , marching with alternate arm movements, forward and backward walking on a treadmill with games, were incorporated to simultaneously challenge balance ,coordination and gait . Obstacle walking and hurdle crossing in water were included for the purpose of gait training. Simultaneously, Pilates, Frenkel’s exercises, balance training, and gait rehabilitation were designed for land sessions. After a 3-week rehabilitation program, the patient demonstrated improved muscle strength and good control over the lower limbs through repetitive exercises in an integrated approach of aquatic therapy and land therapy. Pre and post-intervention outcome assessments demonstrated a notable functional improvement. The scores of the Berg balance scale (BBS) improved from 51/56 to 55/56, while the Dynamic Gait Index (DGI) scores improved from 19/24 to 22/24 after completion of 20 aquatherapy and 10 land sessions. Lower limb coordination improved from moderate impairment during the Pre-Intervention evaluation to mild impairment following the rehabilitation program. The patient could perform heel-to-shin and foot tapping in a coordinated manner, whereas slight incoordination was noted in toe tapping and alternate heel placement. Furthermore, the patient reported enhanced confidence and stability during single-leg stance and ambulation after completion of the rehabilitation program. The case highlights the increasing significance of neurological rehabilitation for patients recovering from certain neurosurgical conditions. The integration of aquatic therapy into neurological rehabilitation may provide an effective adjunctive approach for improving functional recovery, balance, gait, proprioception, and quality of life following brain tumour resection.
Dr. Aishwarya Swaminathan
Dr. Aishwarya Swaminathan is a Physiotherapist at AquaCentric specialising in neurological rehabilitation. She holds a Bachelor of Physiotherapy (BPT) from Nitte Institute of Physiotherapy, Nitte Deemed to be University, Mangalore, and a Master of Physiotherapy (MPT) in Neurology from KLE Institute of Physiotherapy, KAHER University, Belagavi. With 2 years of clinical experience and training in Neurodynamics (NDS), including clinical exposure at NIMHANS, Bengaluru, she provides evidence-based rehabilitation for neurological conditions. She has received an award for scientific paper presentation at AIIMS New Delhi and has published research in peer-reviewed medical journals, reflecting her commitment to advancing neurological physiotherapy and delivering quality patient care.
