Cerebral Palsy

Figure 1. Types of Cerebral Pasly and regions of the brain affectd (http://www.livingwithcerebralpalsy.com/cerebral-conditions.php).

The Cerebral Palsy-International Sport and Recreation Association (CP-ISRA) has developed a system for classification of individual’s functional capacity. This system may be used for individuals with CP as well as other conditions characterized by non-progressive brain disorders. This classification system consists of eight categories and has been used in sport to match athletes’ abilities with sport specific abilities and is available in ACSM’s Exercise management for persons with chronic diseases and disabilities by Durstine et al., 2009.

Given all the challenges that CP individuals face it is not surprising that the level of physical activity in this population is low. The risk for secondary conditions related to physical inactivity such as obesity, hypertension and cardiovascular disease is much higher than their able bodied peers. It is however important to remember that many individuals suffering from CP have normal or above average intelligence, nevertheless their ability to express their intelligence may be limited by difficulties in communicating (Ratanawongsa, 2010). Regardless of intelligence levels all CP patients are able to improve their abilities substantially with the appropriate interventions (Durstine et al., 2009; Ratanawongsa, 2010).

The goal of the exercise training should be to improve health and increase daily functional activities. Exercise programmes will need to be creatively adapted to allow the patient to benefit from a balanced program of muscular strength, flexibility, and aerobic endurance (Durstine et al., 2009). Practitioners should insure that it is taken into consideration the individuals abilities, interests and personal goals (Durstine et al., 2009). The exercises prescribed should be designed so that the individual may be independent in their execution. The progression of exercises should be gradual and should increase at the rate and intensity of the individual in accordance to the principle of specific adaptations to imposed demands (Durstine et al., 2009).

The list of special consideration in exercise testing is also applicable to exercise programming. The primary goal of exercise programming is to identify barriers to participation and design the program in such a way that these are limited and the individual’s interest and abilities are taken into consideration as to enhance their quality of life (Durstine et al., 2009).

These goals are achieved with an exercise program that:

• Is performed at moderate intensity, taking into account spasticity, limited ROM, and pain.
• Entails daily participation.
• Allows for adequate rest between sets and sessions.
• Physical treatments

Stretching is an essential part of any treatment regime for muscle over activity in CP. Spasticity leads to fixed postural deviations, setting the stage for muscle contractures. Stretching counter acts the development of contractures by maintaining the full ROM of affected musculature. Physical therapy treatment goes beyond just stretching however. It is important to include motor retraining, sensory integration, and strengthening (Brashear et al., 2011).  

Strength training has shown to increase the muscle strength of individuals with CP. It has been hypothesised that efforts involved with strength training would increase spasticity in individuals with neurological disorders in turn leading to an increase in joint and muscular contractures and decreased motor function. This however is not supported by the available empirical literature (Dodd et al., 2002). Rather evidence has shown that strength training increased ROM, particularly in the lower limbs (Dodd et al., 2002).

The role of the Biokineticist in this population is to aid them in developing maximal physical and social function. Programs should therefore be aimed at gaining independence in daily activities of living at home, school and work. It is also important to focus on improving mobility, preventing deformity though decreasing spasticity and improving joint alignment. Biokineticists may also have a role in helping the parents of a child with CP set reasonable goals and expectations through educating them about CP. Lastly as professionals it should be ensured that all activities are executed in a safe and fun matter for the patients.
 

References

Brashear, A., & Elovic, E., & Elovic, E.P. Spasticity: Diagnosis and Management. Demos medical publishing. 2011.                                                                                                                 

Dodd, K.J., & Taylor N.F., & Damiano D.L. A systematic review of the effectiveness of strength training. Programs for people with Cerebral Palsy. Arch Phys Med Rehabil. 2002; (83): 1157-64.

Durnstine, J. L., & Moore, G. E., & Painter, P. L., & Roberts, S. O. 2003. ACSM’s Exercise managmetn for persons with chronic diseases and disabilities. American Colledge of Sports Medicine. 3^rd Ed.Human Kinetics.

Living with Cerebral Palsy . Cerebral Palsy. 2011. [Online] Avaliable at: http://www.livingwithcerebralpalsy.com/cerebral-conditions.php [Accessed on 5 September 2011].

Ratanawosngsa, B. eMedicineHealth experts for everyday emergencies, 2011. Cerebral Palsy overview. [Online] Available at:
http://www.emedicinehealth.com/cerebral_palsy/article_em.htm [Accessed 15 August 2011]     .

 

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