Exercise for Children with Cerebral Palsy
Key words
★ Cerebral Palsy= a group of life long neurodevelopmental motor disorders
★ Exercise= planned, structured and repetitive physical activity
So what is Cerebral Palsy?
Cerebral Palsy is an umbrella term used to describe a group of neurodevelopmental disorders resulting from an injury to the developing brain (Ryan, et al., 2017). Globally, it\’s the most prevalent non-progressive motor disability in children. It is a heterogeneous condition, meaning that cerebral palsy presents differently in every individual and presentations can vary in severity. Typically, it affects movement, coordination and balance with secondary complications such as: epilepsy, increased risk of cardiovascular and respiratory conditions, as well as speech and swallowing difficulties (Peterson, 2016).
So where does exercise fit into management?
Due to the diverse nature of cerebral palsy, treatment and management plans are multi-disciplinary and tailored to the individual depending on the severity and personal needs (NICE, 2017). The primary therapeutic goals for cerebral palsy are aimed at improving mobility and upper limb function (Vargus-Adams, et al., 2011), of which exercise can play a key role. It may also help to reduce the risk of secondary presentations, such as cardiovascular and metabolic disease, by helping to improve cardiovascular fitness. However, at present there are no clear exercise guidelines for either children and adults with cerebral palsy (Ryan, et al., 2017).
This can make it difficult to know what exercise to recommend and how effective it is for children with cerebral palsy.
So what does current research suggest?
The list for exercises as a treatment modality for children with cerebral palsy is a long one, so here is a summary of three exercise interventions currently being discussed in literature.
Virtual Reality… more than just computer games
Interest in virtual reality and how it can be applied to exercise, health and intervention has rocketed in recent years. It provides the opportunity to intensify repetitive tasks and increase visual and auditory feedback, making it a valuable therapeutic tool. VR has been shown to transfer well into exercise regimes for children with CP, helping to improve motor function and balance (Chen, et al., 2018 and Qian, et al., 2020).
Gait training…isn’t just for athletes
For ambulant or semi-ambulant children with cerebral palsy there is positive evidence that treadmill training can promote gait and balance development in children under 12 years old. A recent 2021 systematic review also found that exercise interventions had a beneficial effect on muscle strength and gait speed, but had no effect on gross motor function (Liang et al., 2021). There is however still uncertainty over dosage and frequency for gait training, there is yet to be a “10,000 steps a day” equivalent for those with motor disabilities.
Resistance exercise…is strength better than stretching?
Since the goal of resistance exercise is to build muscular strength, there were some concerns that this would increase muscle spasticity and tone which would limit movement, however recent research suggests a positive effect on resistance exercise improving muscle strength in children with cerebral palsy (Collado-Garrido et al., 2019). A further 2020 systematic review found that the benefits of resistance exercise were further improved when they were goal directed, which produced better outcomes (Novak et al., 2020). However, a recent Cochrane review found that there was low quality evidence that resistance training does not improve gross motor function in children with cerebral palsy (Ryan, et al., 2017). In simple terms the jury is still out on how effective resistance exercise is for children with CP.
So to exercise or not to exercise with Cerebral Palsy?
We may be a little biased here at Ebrook Osteopathy and Sports Clinic but our answer is yes! However, there is no current gold standard exercise type or intervention for children with cerebral palsy. It ultimately comes down to choosing exercises that are interesting, fun and engaging, and adapting them to meet the needs of the individual.
Get Moving for STEPtember!
Most people are familiar with the “10,000 steps a day” recommended target, so why not put your steps into a good cause and help raise awareness for cerebral palsy?
So what is STEPtember?
Takes place between the 1st and 30th of September and is a fundraising event organised by the Cerebral Palsy Alliance Research Foundation (CPARF). The goal is to make as many steps as possible in order to raise money to go towards valuable research for those with cerebral palsy. Despite cerebral palsy being the most common lifelong disability worldwide it is one of the most underfunded, so the CPARF strives to change this by investing in groundbreaking research. At the moment the five main research priorities are…
1. Early detection and early intervention
2. Chronic pain
3. Technology
4. Regenerative medicine (a branch of medicine that develops methods to regrow, repair or replace damaged or diseased cells, organs or tissues)
5. Genomics (a fancy word for the studying of how genetics influences our bodies and health)
So how can I get involved with STEPtember?
That’s the easy part, you can sign up on the CPARF website (see the link below) as either an individual or part of a team. From there on in, all you have to do is move! The brilliant thing is that the 10,000 steps target doesn’t have to be achieved by just walking. Running, dancing and even physical therapy sessions all can contribute towards your 10,000 step target. In fact there are over 60 activities that can transfer into steps, so you can choose what works for you based on your individual mobility and interests! The next step is encouraging people to donate to support you as you go or you can donate a sum at the end of the month.
So let\’s get moving and put those
For more information visit…
https://cparf.org/get-involved/steptember/
References
Apolo-Arenas, M.D., Jerônimo, A.F. de A., Caña-Pino, A., Fernandes, O., Alegrete, J. and Parraca, J.A. (2021). Standardized Outcomes Measures in Physical Therapy Practice for Treatment and Rehabilitation of Cerebral PALSY: A Systematic Review. Journal of Personalized Medicine, [online] 11(7). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303849/ [Accessed 19 Aug. 2021].
Chen, Y., Fanchiang, H.D. and Howard, A. (2017). Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Physical Therapy, 98(1), pp.63–77.
Clutterbuck, G.L., Auld, M.L. and Johnston, L.M. (2020). High‐level motor skills assessment for ambulant children with cerebral palsy: a systematic review and decision tree. Developmental Medicine & Child Neurology, 62(6), pp.693–699.
Collado-Garrido, L., Parás-Bravo, P., Calvo-Martín, P. and Santibáñez-Margüello, M. (2019). Impact of Resistance Therapy on Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 16(22), p.4513.
Garcia-Del Pino-Ramos, S., Romero-Galisteo, R.P., Pinero-Pinto, E., Lirio-Romero, C. and Palomo-Carrión, R. (2021). [Effectiveness of treadmill training on the motor development of children with cerebral palsy and Down syndrome]. Medicina, [online] 81(3), pp.367–374. Available at: https://pubmed.ncbi.nlm.nih.gov/34137695/ [Accessed 19 Aug. 2021].
Liang, X., Tan, Z., Yun, G., Cao, J., Wang, J., Liu, Q. and Chen, T. (2021). Effectiveness of exercise interventions for children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials. Journal of Rehabilitation Medicine, 53(4), p.jrm00176.
NHS Choices (2019). Overview – Cerebral palsy. [online] NHS. Available at: https://www.nhs.uk/conditions/cerebral-palsy/.
Novak, I., Morgan, C., Fahey, M., Finch-Edmondson, M., Galea, C., Hines, A., Langdon, K., Namara, M.M., Paton, M.C., Popat, H., Shore, B., Khamis, A., Stanton, E., Finemore, O.P., Tricks, A., te Velde, A., Dark, L., Morton, N. and Badawi, N. (2020). State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Current Neurology and Neuroscience Reports, 20(2).
Peterson, M. (2014). Physical inactivity and secondary health complications in cerebral palsy: chicken or egg? Developmental Medicine & Child Neurology, 57(2), pp.114–115.
Qian, J., McDonough, D.J. and Gao, Z. (2020). The Effectiveness of Virtual Reality Exercise on Individual’s Physiological, Psychological and Rehabilitative Outcomes: A Systematic Review. International Journal of Environmental Research and Public Health, 17(11), p.4133.
Ryan, J.M., Cassidy, E.E., Noorduyn, S.G. and O’Connell, N.E. (2017). Exercise interventions for cerebral palsy. Cochrane Database of Systematic Reviews.
Get Moving for STEPtember!
Most people are familiar with the “10,000 steps a day” recommended target, so why not put your steps into a good cause and help raise awareness for cerebral palsy?
So what is STEPtember?
Takes place between the 1st and 30th of September and is a fundraising event organised by the Cerebral Palsy Alliance Research Foundation (CPARF). The goal is to make as many steps as possible in order to raise money to go towards valuable research for those with cerebral palsy. Despite cerebral palsy being the most common lifelong disability worldwide it is one of the most underfunded, so the CPARF strives to change this by investing in groundbreaking research. At the moment the five main research priorities are…
1. Early detection and early intervention
2. Chronic pain
3. Technology
4. Regenerative medicine (a branch of medicine that develops methods to regrow, repair or replace damaged or diseased cells, organs or tissues)
5. Genomics (a fancy word for the studying of how genetics influences our bodies and health)
So how can I get involved with STEPtember?
That’s the easy part, you can sign up on the CPARF website (see the link below) as either an individual or part of a team. From there on in, all you have to do is move! The brilliant thing is that the 10,000 steps target doesn’t have to be achieved by just walking. Running, dancing and even physical therapy sessions all can contribute towards your 10,000 step target. In fact there are over 60 activities that can transfer into steps, so you can choose what works for you based on your individual mobility and interests! The next step is encouraging people to donate to support you as you go or you can donate a sum at the end of the month.
So let\’s get moving and put those
For more information visit…
https://cparf.org/get-involved/steptember/
