Cerebral palsy refers to a group of permanent congenital disorders that affect movement, balance and posture. It is one of the most common physical disabilities in children, appearing in 2 to 4 of every 1,000 live births in the United States. Exercise is beneficial and recommended for people with cerebral palsy because it can improve health, fitness and quality of life.
Characteristics
Cerebral palsy appears at birth or during early childhood and is caused by damage to the part of the brain that controls muscle tone and spinal reflexes. Brain damage may occur from abnormal development before birth or from direct trauma to the brain. As a result, people with cerebral palsy lack control over body movement and may also have difficulties with sensation, perception, cognition, communication and behavior.
Classification
The extent of disability in people with cerebral palsy is variable and depends on the location and size of the affected part of the brain. The Cerebral Palsy International Sport and Recreation Association (CP-ISRA) has developed an eight-level categorization system to group people with cerebral palsy based on ability level. CP1 represents the most severely affected; usually those who require a motorized wheelchair and CP8 represents those who are minimally affected and are able to walk.
Benefits
Compared to able-bodied individuals, people with cerebral palsy are less likely to exercise. Sedentary lifestyle increases the risk of developing diabetes, heart disease, obesity and certain cancers. Regular exercise can decrease these risks. People with cerebral palsy have reported that exercise helps to decrease muscle spasms and unintentional writhing movements (athetosis). Improved fitness resulting from exercise can help people with cerebral palsy to perform activities of daily living with more ease and independence. On a psychological level, exercise improves self-confidence, body image and overall quality of life.
Challenges
Common cerebral palsy medications such as anti-seizure medications, anti-spasm medications and muscle relaxants may have an effect on exercise ability and motivation. because the goal of these medications is to depress and relax muscle function, side effects may include drowsiness, lethargy, weakness and lack of muscle tone, making exercise difficult. Other side-effects that may affect exercise are nausea, dizziness, irritability and mental confusion.
Programming
A general exercise program for a person with cerebral palsy should incorporate aerobic exercise, strength training and flexibility training. Aerobic exercise should be performed 3 to 5 days per week, strength training twice per week and stretching daily. For people who use a wheelchair, special focus should be placed on stretching on hip flexors, chest muscles and hamstrings. Gradual progression is recommended and frequency and duration of exercise should be increased before increasing intensity.
Considerations
Functional ability must be considered before choosing exercise equipment. People with cerebral palsy who can walk on their own may use a treadmill, possibly with a body support system if walking ability is limited. Arm cycling, wheelchair propulsion and recumbent cycling can be used as aerobic activity for people who cannot walk independently. For both arm and leg cycling, hands and feet should be comfortably strapped to the handles or pedals. For strength training, weight machines or resistance bands may be safer than free weights if spasticity and coordination are a problem. After an exercise session, be aware that physical fatigue may cause increased spasticity.
References
- "ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities;" American College of Sports Medicine; 2009
