Continuity of exercise training program from childhood CP to adulthood CP

Practice for infant and young CP child

Trained gross motor component Strengthening exercise Enable functional activities
(Velicrovic et al, 2005; Damiano et al, 2002)

Case Study
Patient data ICD : : Female, 17 years old , student CP, GMFCS III, spastic diplegia, strabismus

Medical history 2002 : Psoas-hamstring lengthening , talocalcaneaire arthodesis left/right 2003 :Botox treatment m. biceps femoris right 2007 :Eye-operation Devices: Elbow chrutches, backward rollator, floor-reaction orthesis(FRO), Semi-Orthopedic Footware(SOF), KAFO, three-wheels bike/tricycle

Three weels bike

Backward rollator

KAFO

FRO

Initial data
Patient transfer report: Received physiotherapy at former school Home exercises: 30 minutes stretching exercises with KAFO GMFM last 4 years stabile Abel to stand alone for 2 seconds L. Abel to walk 10-15 steps with support Climbing stairs alterneted, with help of railing Activity: ADL-independend Cycling (<1500m) Walking with backward rollator (<100m) Walking with chrutches(<50 meter) Participation: Wheelchair-hockey, horseriding

Patients problems
H1: Muscle strength has been decreased in lower extremities

H2: The AROM of knees and hips have been decreased by lack of strength in extenders and abducters of spastic antagonists
H3: ADL-activities are using more energy and time than before

Anticipated problems
When L. is losing functional activities at this age, she has got a bigger chance to a passive life style in adulthood. This will lead to bigger problems in participation

Durstine et al.

Exercise and CP
1) Concept of exercise training for CP child and adolescent 2) Endurance training from child to adolescent 3) CP child management in India

Functionally based exercise program for children and adolescents with CP

Lacking in practice : Continuity of exercise program from child to adult phase

Need to improve : agility short term muscle power endurance capacity (Verschuren et al, 2009)

Treatment for cerebral palsy children in India

AIMS OF TREATMENT
to reduce spasticity to improve balance and posture to increase mobility to increase muscle strength

Treatment
Early Stage of Cerebral Palsy 1) Stretching : Passive sustained slow stretch without jerks 2) Tilt Table : To improve weight bearing via proprioceptive input 3) Use of splints 4) Mat Exercises

LATER STAGE OF CEREBRAL PALSY

Increasing muscle strength through resistive exercises. Contracting the muscle against

resistance followed by a gentle

stretch might be a good treatment

option to reduce spasticity.

(cont..)
Elbow crutches- to maintain erect posture and improve thalamic input Improve balance and co-ordination (playing with ball, reaching out, swiss ball training, etc) Blowing whistle to increase power of facial muscles and train the respiratory muscles. ADL training

LIMITATIONS
Ignorance Uneducated mothers Unawareness in society about the condition Delay in early intervention Poverty Lack of hospital facilities to detect Cerebral Palsy in rural areas
(Kaur et al 2006) (De Souza et al 2006)

FUTURE IMPLICATIONS
Exercise Prescription Increased speed- Treadmill (slings) Increased resistance- Static Bike Increased duration