Cerebral Palsy and Exercise
Introduction to Cerebral Palsy and Exercise
This article is relevant to multiple audiences including: individuals with disabilities, disability, health, fitness, professionals, community- based service providers, program administrators, managers, CTRS, families, and caregivers.
The article highlights treatment approaches for Cerebral Palsy and how individuals with Cerebral Palsy are more likely to develop secondary conditions. The article reviews research on the use of resistance training as a form of exercise for people with cerebral palsy and its impact on function. The article reviews aspects of cardiorespiratory fitness levels for people cerebral palsy; fitness testing, health needs, and offers exercise guidelines for people with cerebral palsy.
The article reviews treatment trends and approaches used for cerebral palsy including physical therapy and Neuro-Developmental Treatment. The article presents findings from several studies focused on resistance training and cardiorespiratory fitness. Fitness testing and measures for people with cerebral palsy are reviewed. The article reviews research on energy cost of walking in children with cerebral palsy. The article also examines the impact of secondary conditions on exercise for people with cerebral palsy. Through the noted research and literature review, considerations are presented for the development of Exercise Guidelines for people with cerebral palsy. The author also suggests areas where further longitudinal investigation is needed.
Despite the emphasis on physical activity and health over the last 30 years, exercise guidelines for people with disabilities, particularly guidelines for people with cerebral palsy is limited. The article reviews treatment trends from 1900 to present for cerebral palsy including the use of Physical Therapy and the Neuro-Developmental Treatment (NDT) approach. The article indicates there is very little scientific evidence to demonstrate that any one therapy is more or less effective in improving the long-term function of people with cerebral palsy.
Research findings on the use of resistance training is examined. Highlighted research includes studies by McCubbin and Shasby which examined the effects of a resistance training program on elbow extensor strength and Holland and Steadward that looked at the effects of resistance and flexibility training.
Research has shown that resistance training improves neuromuscular function and motor performance. The use of resistance training with an emphasis on rate of movement produced a training effect for people with cerebral palsy that was similar to people without disabilities. Research on the use of resistance training has been found to improve strength, flexibility, and improvement in fine-motor tasks.
The author examines the work of Olney and colleagues which evaluated the work and power of major muscle groups. From the study results, the author concludes it is important to assess individual muscle groups to determine any asymmetrical weakness that may impose a greater burden on walking. Research by King and colleagues is also referenced, noting that training on an adapted device which promotes an upright movement pattern similar to walking is likely to improve motor control in gait.
The article discusses studies by Kramer and MacPhail. The studies explored the relationships between walking efficiency, gross motor ability, and isokinetic strength - the torque produced by a muscle group in a maximal muscle action. The research shows a direct relationship between knee extensor strength and efficient walking and gross-motor ability.
Research also shows progressive resistance exercise training can improve muscular strength and wheelchair performance.
The article examines results from research studying: the effects of quadriceps femoris muscle strengthening, muscle responses to heavy resistance training, and using a resistance training program to increase strength in certain targeted muscles.
Studies show that people with cerebral palsy have lower values for heart rate, oxygen uptake, ventilation, and blood lactate concentrations. Findings from studies measuring Aerobic Power and Anaerobic Power are reviewed. The author notes that when involving people with cerebral palsy in research tests (e.g. V02) it is important to find a modality that allows the person to achieve a maximal performance.
Research examining the energy cost of walking are reviewed. The author concludes that an exercise prescription based on heart rate intensity formulas should be accurate for people with cerebral palsy. Two organizations that promote sports for people with cerebral palsy are highlighted.
The article discusses the influence that secondary conditions (e.g. musculoskeletal deformities contracture, bowel and bladder problems) may have on an exercise prescription. The author identifies that children with cerebral palsy have poor bone density and research showing differences in muscle fiber composition and muscle histopathology are reviewed.
Conclusion & Recommendations:
The author identifies the need for more research noting there is a pressing need to study the activity patterns and physiological responses to exercise in people with disabilities including those with cerebral palsy. Research needs include: longitudinal research on training for people with cerebral palsy. Research should focus on: resistance training, flexibility training, and the functional outcomes for people with cerebral palsy. The focus of research should extend beyond children and young adults and include middle- age and older adults with cerebral palsy. Data on body composition is identified as a research gap. The author suggests that research using field-based (i.e., skinfolds) and laboratory instruments (i.e., DEXA) to assess body composition is needed.
Additional research is needed to evaluate the determining factors of exercise and barriers to exercise for people with cerebral palsy. Training modalities for improving fitness also need to be explored including accessibility of fitness equipment and fitness programs.