Exercise Programming for Clients with Cerebral Palsy
By Jennifer Green, B.S.
|Jennifer Green, NCHPAD Visiting Information Specialist|
Some symptoms include a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, crouched or "scissored" gait; and, finally, muscle tone that is either too stiff or too "floppy." It is vital to remember that CP has varying degrees and not all persons with cerebral palsy exhibit the same symptoms.
There are a variety of health and social benefits associated with exercise in this population, including increased participation in individual and community activities; improved sense of well-being and a reduction in anxiety; increased lung and heart efficiency; increased strength, flexibility, mobility, and coordination; improved bone health; weight control; and a reduction of chronic diseases and secondary conditions. In order to acquire these personal benefits, an effective and safe exercise prescription needs to be created. According to the American College of Sports Medicine, the same guidelines proposed to the general population can be applied to individuals with CP. However, due to the impact that CP has on neuromotor function, there are several modifications and considerations to keep in mind.
The exact frequency, intensity, time, and type of exercise for health/fitness benefits in persons with CP are unknown. Even though the design of the exercise training program should be based on the same principles as the general population, "modifications to the training protocol may have to be made based on the person's functional mobility level, number and type of associated conditions, and degree of involvement of each limb." Due to the fact that there is a lack of motor control, energy expenditure is high at low power-output levels. Aerobic exercise programs should start with frequent, but short bouts of moderate-intensity (40-50% Vo2R). Recovery bouts can be implemented as soon as this percentage is exceeded. Once your client is comfortable, you can progress the exercise intensity to reach 50% to 85% VO2R for a duration of 20 minutes. Persons with CP fatigue easily because of poor economy of movement (meaning the rate of energy expenditure during any motor task); therefore, it is important to tailor the activity, intensity, and duration to your client. The use of short intervals and relaxation and stretching sessions throughout the training sessions can help to decrease fatigue. Types of aerobic activity can include arm cycling, chair aerobics, dancing, jogging, leg cycling, rowing, swimming, walking, water aerobics, and wheeling. Resistance training for persons with cerebral palsy is important because it helps to increase their strength without an adverse effect on muscle tone. These exercises should be designed to "target weak muscle groups that oppose hypertonic muscle groups, improve the strength of the weak muscle group, and normalize the tone in the opposing hypertonic muscle group through reciprocal inhibition." It is also recommended to have your client perform slow, dynamic strengthening exercises over the full range of motion. Finally, it is important to include a proper warm-up and cool-down, as well as a stretching session to help maintain muscle length and flexibility; ballistic stretching should be avoided.
There are several special considerations when creating an exercise program for persons with CP. First of all, the exercise program should change consistently with changes in muscle tone, rehabilitation, and medical interventions. Also, good positioning of the head, trunk, and proximal joints of extremities is advised. If necessary, try inexpensive modifications that enable good position, such as Velcro gloves to attach the hands to equipment (if the client has trouble with gripping). Finally, it's important to be aware that individuals with CP are more susceptible to overuse injuries because of inactivity and other associated conditions, such as contractures and joint pain.
Before beginning an exercise program for persons with CP, make sure that they have medical clearance from their physician and you complete a thorough medical history in order to determine any associated conditions they may have. With a little creativity, proper knowledge of cerebral palsy and the tools to create an effective fitness program, you can assist in creating a better quality of life for your clients.
Cerebral Palsy Source. (2005). Retrieved July 27, 2010, from ( http://www.cerebralpalsysource.com/About_CP/facts_cp/index.html)
Exercise principles and guidelines for persons with cerebral palsy and neuromuscular disorders. (1999). Retrieved July 27, 2010, from ( http://www.ucp.org/ucp_channeldoc.cfm/1/15/11500/11500-11500/639)
NINDS cerebral palsy information page. (2010). Retrieved July 27, 2010, from (http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm)
Thompson, W. R., PhD, FACSM, Gordon, N. F. MD, PhD, MPH, FACSM, & Pescatello, L. S., PhD, FACSM (Eds.). (2010). ACSM's guidelines for exercise testing and prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.
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