Exercise – A Key Factor in the Management of Cerebral Palsy – Case Study

Cerebral Palsy (CP) is an umbrella term referring to a group of disorders affecting a person’s ability to move. It is due to damage of the developing brain during pregnancy or shortly after birth. Every 15 hours an Australian child is born with CP, making it the most common childhood physical disability. Worldwide 17 million individuals are currently living with CP, a permanent life-long condition. Although there is no cure, exercise is an important aspect in helping to manage CP. Individuals with CP will often have reduced cardiorespiratory endurance, muscle strength and typically participate in reduced levels of physical activity. Reduced cardiorespiratory endurance and muscle weakness pose a significant risk for negative long-term health outcomes and early cardiovascular mortality.
It has been well established that exercise is key when it comes to improving cardiorespiratory endurance, muscle strength and reducing risk of chronic/cardiovascular diseases. As these are all conditions significantly correlated with CP, it is imperative that individuals begin participating in an individually tailored exercise intervention as early as possible.

CASE STUDY:

Last year I worked with a 9-year-old female with spastic hemiplegia (left side affected). She was classified on the Gross Motor Function Scale (GMFCS) as a Level 2. The GMFCS rates a child on their independent ambulation ability from Level 1 to Level 5. Level 2 meant that she could walk in most settings but need assistance climbing stairs or when walking long distances and had minimal ability to perform gross motor skills (running and jumping). Primary concerns were surrounding muscle rigidity, weakness in upper limbs, and low functional ability. Initial testing showed that she had poor cardiorespiratory fitness and was unable to complete a 6-minute walk test without physical assistance. She also presented with poor strength, poor flexibility/balance and tight musculature.
Her goal over the 12-week programme was to walk alongside her peers without assistance and participate more in school soccer. For the first 6 weeks her programme was largely based around functional strength training, upper limb stretching and lower limb gait retraining through the utilisation of mirror box therapy. The next 4 weeks were based around combining her training into more complex skills. I largely focused on improving her cardiovascular fitness and lower limb strength through functional training and mini soccer games. Finally, we progressed her onto practicing with her peers. Despite 12 weeks being a small amount of time, we were able to make significant changes. At the end of the programme she was able to complete the 6-minute walk test without assistance and with an improved gait. Her strength and balance also improved, and she was able to participate confidently in a soccer game with her friends. Her flexibility was still below average, but she was given a home programme to continue to work on this. Ultimately the exercise programme was a success with this client, as her confidence had dramatically improved along with her quality of life.
If you or your child has CP, come and see an Accredited Exercise Physiologist at Absolute Balance. A thorough initial consultation/assessment will help us to determine what exercise would be most suitable to ensure the best long-term outcomes.


Lauren Kearsley
Master Clinical Exercise Physiology | Bachelor of Science (Anatomy & Physiology)
Accredited Exercise Physiology (AEP, AES, ESSAM)

References:
1 Cerebral Palsy Alliance. (2018). What is cerebral palsy? | Cerebral Palsy Alliance Research Foundation. Retrieved from https://research.cerebralpalsy.org.au/what-is-cerebral-palsy/
2 Stackhouse, SK., Binder-Macleod, S., Lee, SC. (2005). Voluntary muscle activation, contractile properties and fatigability in children with and without cerebral palsy. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15779003
3 Verschuren, O., Peterson, M., Balemans, A., Hurvitz, E. (2016). Exercise and physical activity recommendations for people with cerebral palsy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4942358/