Resistance Training Guidelines for Cerebral Palsy
Cerebral palsy is a non-progressive disorder that results in physical impairment and causes postural and balance problems. It affects approximately 25,000 children each year (Schwartz, Engel, & Jensen, 1999). The disorder is caused by an injury to the brain before, during, or after birth. To be diagnosed with cerebral palsy, the person must have a non-progressive lesion to the brain that causes motor dysfunction usually before the age of 3 (Schwartz et al., 1999). The injury does not result in damage to the muscles or nerves in the spinal cord, but rather, to the motor center of the brain that controls muscle function. The more severe the injury to the brain, the greater the limitation in movement and function (Gersh, 1991).
Resistance Training Guidelines
1. The strong pull of the hip adductors seen in many persons with cerebral palsy will require a resistance training program that places greater emphasis on strengthening the hip abductors. This does not necessarily mean that the hip adductors do not need to be strengthened. While the adductor muscles are often very tight due to spasticity, they may also be very weak. Therefore, both sets of muscle groups must be strengthened even though the abductors might have to receive a greater amount of work. Make sure that clients have not had a hip dislocation prior to working these muscle groups. If they have had a hip dislocation, seek advisement from their primary care physician or health provider to determine if hip exercises can be conducted safely.
2. Flexibility training is a very important part of the exercise prescription for persons with cerebral palsy because of the high level of spasticity. Resistance training programs should include nearly the same amount of attention to enhancing and/or maintaining good range of motion in the affected limbs.
3. A common type of cerebral palsy that results in weakness or paralysis to the right or left side of the body is spastic hemiplegia (a similar condition occurs in persons with stroke). This condition will often require greater attention to developing strength on the weaker side of the body. Determining how much improvement can be made to the hemiplegic side will depend on the amount of damage that was sustained to that part of the central nervous system. If the person has complete paralysis to one side of the body, resistance training should be substituted with flexibility training.
4. Since balance is often impaired in ambulatory persons with cerebral palsy, it is important to protect clients from injury by developing safe resistance training programs that do not expose them to a high risk of injury. Some clients will be able to work on strength exercises in a standing position with physical assistance from the instructor, while others will have to perform the exercise routines from a chair. The instructor should measure the client's static and dynamic balance before developing the resistance training program to determine if standing exercises are safe.
5. In individuals who have spastic cerebral palsy, the antagonistic muscles, which directly oppose the action of the prime mover, are not inhibited. This is the result of a hyperactive stretch reflex that responds to the change in length of the muscle fibers by overreacting with a forceful contraction (Lockette & Keys, 1995). For example, during elbow flexion, the triceps are supposed to serve as the antagonists directly opposing the biceps and brachialis. When reciprocal innervation is absent; both muscles contract simultaneously causing significant movement dysfunction and jerky actions. The instructor should try to work with the client in assuring the smoothest movement possible, but should not be alarmed if there is some jerkiness during the movement phase. This is normal for persons who have this condition.
6. Certain individuals with cerebral palsy have a condition known as athetosis. This condition results in involuntary movements that occur in one or more of the person's limbs. The movements are uncontrollable and are often referred to as slow and 'writhing.' Facial muscles are also involved, which make the person appear to be laughing or crying. Since the movement of muscle groups is involuntary, use of free weights may not be possible because the hand may open reflexively during the weight routine. Elastic bands may also be a problem since the resistance may be difficult to control and may result in the band snapping back too quickly. Cuff weights and machines are the most appropriate modalities. Active-assistive exercise may be needed to perform the motion smoothly.