Cerebral Palsy and Health
When developing exercise guidelines for persons with cerebral palsy, it is important to consider secondary health conditions that may impact or limit a person's ability to participate in certain physical activities. One of the pioneers in the area of health and cerebral palsy is Dr. Margaret Turk. In a recent article, Turk and coworkers evaluated the health status of 63 women with cerebral palsy residing in the community. The secondary conditions found in this sample that may have an impact on an exercise prescription were as follows: pain, musculoskeletal deformities, and bowel and bladder problems. The associated conditions reported in the sample were: seizures, intellectual disabilities, learning disabilities, and sensory disorders.
Turk and coworkers reported that pain was found in 84 percent of the sample and limited the activities of 56 percent of the sample. The most common sites for pain were the head (28%), back (26%), and arm (23%). Musculoskeletal deformities were reported in 59 percent of the women. Seventy-five percent had some type of contracture, with the most common sites being the ankle, neck and hip. Forty percent of the sample had at least one hip deformity and 53 percent had kyphosis or scoliosis. Leg-length discrepancies were seen in 44 percent of the women. Fifty-nine percent reported having both a hip and back deformity. Bowel and bladder problems were reported in 56 percent and 49 percent of the sample, respectively. Surprisingly, 83 percent of the sample reported engaging in at least one common physical activity, including swimming, walking, use of exercise equipment, and weight lifting. However, there were no data reported on the qualitative aspects of the exercise.
In what will surely be one of the pioneering studies on the health status of women with cerebral palsy, Turk and coworkers provide some valuable input on secondary and associated conditions that will be helpful to the Task Force in preparing exercise guidelines for persons with cerebral palsy. The following comments related to physical activity should also be considered in exercise guideline development over this two-day meeting:
"The significant association of the ability to walk and participation in physical activity, and of wheelchair use and physical activity, show the importance of physical function in exercise-based health promotion activities. These findings suggest that the use of mobility devices and other adaptive equipment are important considerations in designing exercise interventions. The significant association between stretching and/or doing ROM exercises and hip deformity may be suggestive of the therapeutic need for stretching in the management of a hip deformity. "Similarly, the significant relation between musculoskeletal deformity and engagement in physical activity, such as with back deformity, may indicate the importance of general physical activity as a therapeutic intervention for certain musculoskeletal deformities."
Other health concerns found in persons with cerebral palsy were highlighted in a report edited by Turk, Overeynder, and Janicki entitled, "Uncertain Future - Aging and Cerebral Palsy: Clinical Concerns." In this report, it was noted that musculoskeletal complaints are the most significant problem experienced by adults with cerebral palsy. The pain often originates from soft tissue injuries in muscles, tendons, ligaments, or nerves. The authors noted that the pain may be related to the "way a person performs an activity and often may be the result of repetitive movements over time." Fatigue was also listed as a recurrent complaint of adults with cerebral palsy, and that sometimes pain and fatigue are experienced together.