Do you have any exercise suggestions for an adult client with Cerebral Palsy? I would appreciate any advice you could give me on this condition.
Cerebral Palsy (CP) is a term used to express a condition caused by injury to the parts of the brain that control our body movement and muscle co-ordination. "Cerebral" has to do with the brain, and "palsy" means weakness or problems with using the muscles. Development of the brain starts in early pregnancy and continues until about age three. Harm to the brain throughout this time may result in cerebral palsy.
This damage interferes with the communication from the brain to the body and from the body to the brain. CP cases can be mild, moderate or severe. The effects of CP differ extensively from individual to individual. A mild case of Cerebral Palsy might result in a slight discomfort of movement or hand control. A severe case of CP may result in nearly no muscle control, greatly affecting movement and speech. Depending on which areas of the brain have been injured, one or more of the following may occur:
- Muscle tightness or spasms
- Involuntary movement
- Difficulty with "gross motor skills" such as walking or running
- Difficulty with "fine motor skills" such as writing or doing up buttons
- Difficulty in perception and sensation
These conditions may cause difficulties in many other things that take place in everyday living such as feeding, poor bladder and bowel control, breathing problems and pressure sores. The brain damage that caused CP may lead to other problems such as seizures, learning disabilities or developmental delay. The level of intelligence of a person with CP is not indicated by the degree of physical disability he or she may experience. It is important to remember that the body parts that are not affected by CP can feel pain, heat, cold and pressure.
People with Cerebral Palsy have a normal life span. It is not a progressive disorder. Damage to the brain is a one time event, so it will not get worse. The effects of CP may change over time. Some may improve.
Maintaining Physical Health
A lifestyle that involves regular exercise and good nutrition is essential for everyone, including individuals with disabilities. A good general fitness level will help with range of motion and flexibility, and exercise to improve cardiovascular fitness can improve endurance and help balance age-related changes that lead to fatigue.
An exercise program should be individualized to meet the goals of each person. Realistic performance goals need to be set at the beginning. Exercise should be engaged at least three to five times a week, and the duration of each exercise session needs to be adjusted periodically, but in general should start out at 10 to 20 minute sessions. All components of physical activity should be included in a program such as cardiovascular, flexibility, endurance training and strength training.
To increase and maintain heart and lung efficiency:
- Aerobic exercises can also contribute to weight control.
- Cardio training will increase your heart rate to a moderate level above the resting level for a sustained period of time during moderate to vigorous activity.
- Start the program with five minutes of exercise, gradually increasing the length of exercise anywhere up to 20 to 60 minutes.
- Best if done at least three times a week (can be done daily).
- Caution: It is important to choose exercises that reduce stress on joints and muscles, mainly in previously overstressed areas.
To improve flexibility and range of motion:
- Individuals with CP are at risk of having muscle tightness that restricts motion at joints and loss of functional mobility can be associated with pain.
- Focus on muscles that are causing the most problems with mobility in daily activities.
- Stretch the muscle slowly to the point of tension but not pain.
- Hold each stretch for 30 to 60 seconds and do it two to three times.
- Stretch the muscle several times a day to improve both flexibility and range of motion.
To improve and maintain bone structure and strength:
- Individuals with CP and neuromuscular disabilities are at risk of being inactive or immobile.
- Inactivity or immobility decreases bone density and strength (e.g., osteoporosis).
- Weight bearing in combination with movement of the body and limbs and muscle exercises are believed to prevent loss of bone structure and strength.
- If your client has been inactive, start at a level that is comfortable for him or her. Increase the effort and duration gradually.
To strengthen muscles and increase endurance:
- Higher weight and less repetitions increases strength. Moderate weight and more repetition increases endurance. You can exercise one muscle or joint at a time or several muscles. Focus on a balanced program with emphasis on those muscles that will help you in everyday activities.
- Following a strength training exercise for a certain muscle group, a one day rest period is important before repeating the exercise for that muscle group.
- Expect mild temporary soreness for up to 48 hours at the beginning of the program and as intensity is increased.
- Initiate the program for each muscle group by performing 10 comfortable movements against a resistance over time. Increase the load gradually and decrease the number of repetitions. Two sets of each of the movements can be performed in a beginning program.
- Aim for 10 repetitions. If muscles feel fatigued after two to four repetitions, the load is too high. If the client can complete 12 to 15 repetitions, the load is too low.
- Muscle strengthening exercises are most effective when they are focused primarily on the muscle group opposite the tight muscle group. For example, if the muscles that bend the elbow are tight, stretch and strengthen the muscles that straighten the elbow.
Always include a warm up and stretching session before and after a workout to prevent muscle strain and fatigue.
Benefits of Exercise
- Increases participation in individual and community activities
- Improves the sense of well being and reduces anxiety
- Increases and maintains heart and lung efficiency
- Increases and maintains strength, flexibility, mobility and coordination
- Improves and maintains bone structure and strength
- Assists in weight control
- Reduces risks of several chronic diseases (e.g., high blood pressure, osteoporosis)
- Arm Cycling - An activity that simulates bicycling but is done with the arms instead of the legs. Participants may use stationary indoor equipment called "erogmeters" or specially designed arm-driven cycles for outdoor cycling.
- Chair Aerobics - A combination of upper body movements and stretches designed to increase flexibility and cardiovascular endurance. These are performed in a seated position.
- Dancing - An exercise done to music so the tempo of the music determines the speed of movement and the intensity. A specific heart rate zone should be predetermined. Correct body alignment, breathing intensity and range of motion must be carefully considered. Caution: Can be harmful to persons having significant contractures or bone density loss.
- Exercise Bands - The use of wide elastic bands for resistance training and stretching. All stretching should be slow.
- Jogging - The act of fast walking or running at a steady pace. Jogging can be done inside, in place, on a treadmill or on a track. It can also be done outdoors. Use of properly fitted exercise shoes is recommended. Mild muscle soreness may result at the start of the program. If joint discomfort develops, consider a lower type of impact exercise such as vigorous walking or swimming. Caution: Can be harmful to persons having significant contractures, bone density loss or degenerative joint disease.
- Leg Cycling - An activity on a mobile vehicle (2 or 3 wheel) or on stationary equipment. Outdoor equipment often has gears to assist on hills. Indoor equipment often has mechanical or electronic programs for controlling resistance.
- Rowing - A total body exercise in a seated position using stationary equipment. It involves repetitive pulling by both arms against a resistance, coordinated with straightening and bending of both legs.
- Stair Climbing - The action of walking up stairs. This can be done on specific exercise equipment which simulates stair climbing or on actual stairs. Mild upper leg muscle soreness or joint soreness may result at the beginning of the program.
- Swimming/Water aerobics - The act of moving progressively in water by means of purposeful use of the arms/hands and of the legs/feet. Accommodate clients to the water temperature slowly (75 to 85 degrees F is ideal for water temperature). Water resistance can produce the same cardiovascular effect as exercise on land. Focus exercise on one area at a time with repeated motions, gradually increasing speed and duration. Devices also should be used such as an aqua vest, weights, styrofoam dumbbells/exercise equipment, special gloves, etc.
- Walking - The act of moving or advancing by foot with one foot on the ground at all times. Vigorous walking is a convenient exercise that can be done anywhere with or without an assistance device (i.e., cane, crutches, walker). Caution: Can be harmful to persons with significant contractures or advanced bone density loss. Joint pain is a warning sign of too much impact.
- Weights Training - The use of free weights or exercise machines that provide resistance. Done at home or in an exercise facility. Weak muscles can be made stronger by placing resistance against the target muscles for short durations. Load increases strength, and repetition increases endurance. The level of resistance and the number of repetitions of each exercise can be varied to produce the desired results. Don't lift free weights alone.
- Wheeling - Propulsion of a wheelchair by the arms or legs over an extended distance. Vigorous wheeling can be done inside or outside. It can be done using a conventional wheelchair or a specialized sport wheelchair, with or without a wheelchair roller. If wheeling outside, precautions should be taken for street traffic.
- Yoga and Tai Chi - A physical form of yoga involving breathing and stretching exercises and maintaining various positions for a short period of time. Tai Chi is a series of individual dance-like movements linked together in a slow, continuous, smooth flowing sequence. For these activities, no additional equipment is needed.
Perform wheelchair based exercises when motor control is an issue. When working with a client with CP in a wheelchair, some of the best pieces of equipment are small ankle bands and tubes. How do you effectively work their legs? Place the small band around their ankle apply some resistance and have them lift their leg up and down, teaching proper breathing. Try for two sets of 15. To improve ROM, assist with leg circles and an assisted leg stretch.
Tie or place the tube around their arm, depending on if they have control of their hands and can hold it. Use different ranges of motion to arm lifts up, down and to the side. Perform two sets of 15 to start and then increase band strength for all exercises.
You can also do seated ab work. Assist clients by using their breath and have them push and pull away from their hand, which is resting on their belly. If there is a learning disability, this is one of the best ways to get clients to contract the core.
Key things to watch for in clients with CP include the following:
- Posture - Ensure clients set their posture, especially when doing arm and core exercises that they are not rounding forward.
- Allow for rest breaks and give lots of encouragement.
- Some days may be better then others for muscle tightness and soreness.
- Allow participant to properly stretch using assisted stretches.
- Keep on a routine and try not to add in to many new exercises. You may have to track clients' progress a little longer with the same routine.