Cerebral palsy (CP) is a term used to describe a group of disorders that affects movements of the body, balance and posture. A very basic definition of CP is “brain paralysis.” Impairments usually appear early in life during infancy and early childhood. There is no cure for CP but with early treatment some associated disabilities can be reduced. According to researchers at Ball State and the University of Oklahoma Health Science Center, CP is one of the most common physical disabilities in the United States, affecting 1.5 to five of 1,000 live births.
Types of Cerebral Palsy
The three types of cerebal palsy are: spastic, dyskinetic and mixed.
Spastic CP is associated with increased muscle tone resulting in stiff muscles and jerky movements, accounting for 70 to 80 percent of all cases.
Dyskinetic CP affects coordination of movements and consists of two subcategories, athetoid and ataxic. A person with athetoid CP has movements characterized as slow and writhing. The individual with ataxic CP has trouble with movements that are quick or require a great deal of control such as writing.
The third type of CP is usually a combination of different types. The most common combinations of mixed CP conditions are between the spastic and the athetoid.
Cerebal Palsy and Exercise
There is limited research available concerning exercise response for individuals with CP. However, there is no reason to suspect that persons with CP would not benefit from a regular program of exercise involving cardiovascular fitness, muscular strength and flexibility training. Fitness gains may only be limited to activities of daily living but have the ability to improve the individual's overall sense of well-being.
It is recommended that the afflicted seek help from a professional experienced in creating fitness programs for special populations. Because each person is affected differently by CP, their individual abilities, goals and interests should be considered when creating a fitness program. Start slow and make gradual changes.
Cardiovascular exercise is recommended to improve aerobic capacity and endurance. Use of the treadmill is not recommended for CP persons with an inability to balance and maintain proper coordination. The Schwinn Airdyne bike, arm ergometer and recumbent bike are the best forms of cardiovascular equipment to use. A program of three to five days is recommended for 20 to 40 minutes at 40-85 percent of heart rate reserve (HRR). HRR is the difference between a person’s maximum heart rate (220 minus your age) and resting heart rate.
Strength Training and Cerebral Palsy
The type of resistance training program will be based on the muscle groups affected and the type of CP. Free weights and weight machines may be used to maintain muscle strength. Overall, the strength-training program should involve exercises for all major muscle groups with special emphasis on areas of weakness.
CP often results in a strong pull of the hip adductors; therefore, strengthening the opposing muscle groups, the hip abductors, is necessary. Also, even though the adductor muscles may be tight, they can also be very weak. They need to be included in the strength-training program. If the person has suffered a hip dislocation, consultation with the primary care physician is necessary to ensure that it is safe to perform hip exercises.
A common type of CP known as spastic hemiplegia results in weakness or paralysis on the right or left side of the body. The strength training program for a person with this type of CP should focus on strengthening the weaker side of the body. If one side of the body is completely paralyzed, flexibility training of the affected side is recommended rather than strength training.
For the individual with spastic CP, the opposing muscle group is not inhibited. For example, during leg extension, the hamstrings are supposed to oppose the quadriceps. Due to nerve impairment, muscles contract simultaneously causing jerky, uncontrolled movements. The job of the fitness instructor is to work with the client to ensure smooth movement.
Some individuals with CP suffer from a condition known as athetosis. Athetosis results in involuntary movements in the limbs. Due to the possibility of involuntary muscle contraction, use of free weights is not recommended. The use of ankle, cuff weights and machines are most appropriate to ensure optimal strength training.
According to the National Center on Physical Activity and Disability Exercise/Fitness, flexibility training is an important part of the exercise program for persons with CP due to high levels of spasticity. The flexibility program should focus on improving range of motion in the affected joints.
The duration of all exercise sessions is more important than the intensity. Each exerciser is different and the fitness program should be created to suit each individual.
- Exercise Management for Persons with Chronic Diseases and Disabilities; American College of Sports Medicine, 1997
- Exercise/Fitness Training for Persons with Disabilities