1. Cerebral Palsy Hannah Dowzycki EXS 486

2. About Cerebral Palsy Neurological disorder that is caused by a brain injury or malformation that occurs when a child’s brain in under development Loss or impairment of motor function caused by brain damage Most common movement disorder in children Occurs in about 2-3 out of 1,000 births

3. Cause of Cerebral Palsy Caused by brain injury or malformation Occurs before, during, or immediately after birth while the infants brain is under development There are four types of brain damage that cause cerebral palsy: 1.Periventricular Leukomalacia (PVL) 2.Hypoxic Ischemic Encephalopathy (HIE) 3.Intraventricular Hemorrhage (IVH) 4.Cerebral Dysgenesis

4. Periventricular Leukomalacia Brain injury that causes damage to the white matter brain tissue Leads to intellectual impairment About 60-100% of infants with PVL are diagnosed with cerebral palsy PVL can occur at any time but mostly occurs when the child is unborn—particularly vulnerable between 26-34 weeks of gestation

5. Hypoxic Ischemic Encephalopathy Caused by oxygen deprivation—brain damage HIE is one of the most common types of brain damage Often leads to severe developmental and/or cognitive delays, or motor impairments

6. Intraventricular Hemorrhage Brain bleed that can damage and kill areas of the brain that are crucial to development and motor function Results in impairment in brain activity to control cognitive and motor functions—the severity of impairment depends on the location and degree of damage.

7. Cerebral Dysgenesis Abnormal brain development Occurs after conception and depending on the severity of brain malformation or abnormal brain development, it can have a variety of effects

8. Classification Based on Severity Mild: child can move without assistance—daily activities are not limited Moderate: child will need braces, medications, and adaptive technology to accomplish daily tasks Severe: child will require a wheelchair and will have significant challenges in accomplishing daily activities

9. Risk Factors Events, substances, or circumstances that increase the risk of developing cerebral palsy Birth Asphyxia Complications during birth Infection Intrauterine growth restriction Multiple births and infertility drugs

10. Signs & Symptoms Many are not readily visible at birth, except in some severe cases, and may appear within the first 3-5 years of life Affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture, and balance It can also affect fine motor skills, gross motor skills, and oral motor functioning

11. Diagnosis Takes time—no test In severe cases, the child may be diagnosed soon after birth Doctors test reflexes, muscle tone, posture, coordination, and other factors MRI, cranial ultra sounds, or CT scans

12. Treatment Can’t be cured, but treatments can help Not one specific treatment Therapy and adaptive equipment Drug therapy and surgical interventions

13. Treatment Continued Various forms of therapy can help improve functionality, mobility, fitness, independence, & more! Some of the many recommended therapies: Physical therapy Occupational therapy Behavioral therapy Hippotherapy Massage therapy Increasing the amount of exercise and physical activities can be beneficial for individuals with cerebral palsy Respiratory therapy Speech therapy Social therapy Acupuncture Aqua therapy

14. Treatment Goals Optimize mobility Manage primary conditions Control Pain Maximize independence Enhance social & peer interactions Master self care Maximize learning potential Optimize ability to communicate Enhance quality of life

15. Case Study 6 year old male, diagnosed with cerebral palsy Uses leg braces to help him walk No cognitive limitations Goals: To play golf To be more independent Better movement—to not be as reliable on braces

16. Exercise Testing Functional assessment of trunk and upper and lower extremities—range of motion, strength, flexibility, balance Bike ergometer—does not require balance Precautions: Results from exercise test in the same individual with CP may vary considerably from day to day because of fluctuations in muscle tone Avoid activities of balance if stability is an issue

17. Exercise Prescription Aerobic Exercise: Daily if possible Moderate activity—noticeable increases in heart rate and breathing 30-60 minutes Enjoyable activities to make it fun & not seem like exercise Walking, swimming, dancing

18. Exercise Prescription Continued Muscle Strengthening Exercise At least 3 days a week As part of their daily exercise time Enjoyable activities to make it fun & not seem like exercise Playground, resistance bands Very important to work on resistance training in CP patients!

19. Client’s Goals Because the client wants to play golf, flexibility will be incorporated with his exercise prescription Focus on client’s range of motion and trunk rotation— same movements seen in a golf swing Will also work on his walking to meet his goal of not relying on his braces as much

20. Conclusion Cerebral palsy is a non-progressive disorder There is no cure, but therapy and other treatments can be beneficial Most children with cerebral palsy can live long, happy, quality lives Important for individuals to take steps to optimize life expectancy and manage cerebral palsy

21. References Cause of Cerebral Palsy. (2016). Retrieved from http://cerebralpalsy.org/about-cerebral-palsy/cause/. Earhart, G., Canning, C., Dibble, L., Rochester, L., & Ellis, T. (2015). Rehabilitation and Parkinson’s Disease: Exercise is as important as medication. Physiotherapy, 1 01, e20-21. Ehrman, J. (n.d.). Clinical exercise physiology (3 rd ed., p 56). Verschuren, O., Darrah, J., Novak, I., Ketelaar, M., & Wiart, L. (2014). Health-enhancing physical activity in children with cerebral palsy: More of the same is not enough. Physical Therapy, 94(2), 297. doi:10.2522/ptj.20130214