Thursday, 4 June 2015

Cerebral Palsy

Cerebral Palsy (CP) is a non-progressive condition that results from a lesion in the brain that occurs either before, during, or shortly after birth, resulting in the abnormal development of the brain. Failure of the brain to develop properly can occur during the first or second trimesters of pregnancy and can be caused by genetic disorders or limited blood supply. A lesion may also develop as a result of injury to the brain before, during, or after birth, such as a traumatic blow to the head or bleeding in the brain.

Depending on the severity of the lesion and the part of the brain affected, individuals with CP will present with varying degrees of disability. However, the general characteristic features of CP are limited mobility, poor coordination, and a limited ability to maintain posture and balance. These individuals may be wheelchair bound, unable to walk at all, or may be able to walk, but with an abnormal gait, or walking pattern. They will also often present with spasticity in the hands and arms, and a misshapen mouth, resulting in drooling and slurred speech. Their cognitive function is usually not affected, therefore, it is important not to treat them as cognitively impaired simply because they drool and have a slurred speech.

Because of the varying degrees of disability in CP patients, every person must be assessed and treated as an individual according to his/her goals and degree of disability. Adaptations to the assessment and management of these individuals will need to be made to accommodate each individual’s needs and goals. Any medications that the individual is taking must be considered, as these may alter his/her response to exercise. It is important to realize that the lesion in the brain cannot be reversed or changed by exercise; however, exercise therapy can help to improve the symptoms of spasticity, poor balance and muscle weakness associated with CP. It is also important to note that a person with CP may experience increased spasticity and decreased coordination shortly after exercise, but this is not uncommon and will return to normal.

Individuals with CP are often sedentary, due to their lack of mobility. This increases their risk of developing sedentary diseases, such as cardiovascular disease and stroke. It is, thus, important that they embark on an appropriate, regular exercise programme in order to reap the physiological and psychological benefits of regular exercise. Improvements in mood and self-esteem are also associated with exercise, which the CP patient will benefit from. The exercise programme should incorporate all the major muscle groups (if still functional) and should be aimed at improving cardiovascular fitness, muscles strength and flexibility, thereby increasing one’s independence to carry out his/her daily activities and, in turn, improving one’s sense of self-worth. A biokineticist can assist in the design, implementation and adaptation of such an exercise programme.

References
ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities

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