1. + Cerebral Palsy Strength Training Kate Silvia Northeastern University

2. + OVERVIEW Cerebral Palsy (CP) is a neurological disorder that affects body movement, coordination and posture. Signs of cerebral palsy typically begin to show during infancy or preschool years. Things such as; exaggerated reflexes, floppiness or rigidity of limbs and trunk, abnormal posture, unsteady gait, or involuntary movements can appear. The disorder causing CP doesn’t usually change with time, so symptoms won’t worsen with age*. There are many different treatment options to implement depending on the type and severity of cerebral palsy * Muscles may weaken because of aging, but not because of worsening CP effects *

3. + Example Treatment Methods Postural Correction Balance Training Range of Motion (ROM) or Flexibility Training Cardiovascular training Neurodevelopmental therapy Gait Training Load Bearing Locomotor Training Whole Body Vibration Strength Training

4. + Of the treatment methods mentioned, strength training is the most controversial, especially when implementing the training with children. Children with spastic diplegic cerebral palsy have severe problems with muscle weakness. The primary goal of this training is to strengthen muscles that are needed for movement, walking and coordiantion. Training of the muscles can also be used to target balance and postural improvement. The studies that focus on children so far are contradictory and/or include uncontrolled clinical trials.

5. + Strength Training cont. Muscle weakness had not been recognized as a problem for those with Cerebral Palsy until recently. It has been clinically proven that reduced spasticity has revealed underlying muscle weakness and abnormal movement patterns in many children. For this reason, strength training has been recommended to improve motor function. Functional strength training showed improvements in gross motor function, endurance, and temperospatial measures, such as gait speed and stride length. Many studies have reported positive results in strength training in children with spasticity. A significant relation has been reported between knee extensor strength and both walking efficiency and gross motor ability in adolescents with cerebral palsy. A study on adults with cerebral palsy showed a strength training regimen eight weeks long, three times a week showed improvements in endurance, strength and range of motion.

6. + The images show a strength training regiment of Physio Tool, Ltd, Malmö, Sweden. This program focuses on the legs in order to improve walking and gait. Training Program

7. + Strength Training Across the Ages Many studies have reported positive results in strength training in children with spasticity. These studies so far however, are contradictory and/or include uncontrolled clinical trials. Many studies don’t have a big enough pool in order to prove their findings. Another issue that comes up with testing children, is the supervision of exercise. Some of the trials implemented home exercise in order to get more participants. This brings up the issue of proper technique and execution of the exercises while only under parental supervision. Maintaining muscle strength is important for adults because muscle strength, elasticity, and bone density all decrease in the aging process. The strengthening of muscles is even more important for adults with CP, but most usually stop training after reaching adulthood. Usually they are tired of having PT for all their lives. Some return after they find their motor capacity has deteriorated. It is not clear however, if it is possible to increase or restore motor capacity. Functional strength training for adults has showed improvements in gross motor function, endurance, and temperospatial measures, such as gait speed and stride length. ChildrenAdults

8. + References Andersson, C. (2003). Adults with cerebral palsy: walking ability after progressive strength training. PubMed. US National Library of Medicine. National Institute of Health. Damiano, Diane L. (2006). Activity, Activity, Activity: Rethinking Our Physical Therapy Approach to Cerebral Palsy. Physical Therapy. (Vol. 86 pp. 1534-1540). Dodd et all. (2003). A randonmized clinical trial of strength training in young people with cerebral palsy. MacPhail AHE, Kramer JF. (1995). Effect of isokinetic strength on functional ability and walking ef fi ciency in adolescents with cerebral palsy. Dev Med Child Neurol 37:763–75. Taylor, Nicholas F. (2009). Is progressive resistance exercise ineffective in increasing muscle strength in young people with cerebral palsy? Verschuren, Olaf. (2011). Muscle Strengthening in Children and Adolescents With Spastic Cerebral Palsy: Considerations for Future Resistance Training Protocols. Ptjournal.apta.org.

9. + Reflective Note I decided to create this powerpoint for Physical Therapists who want to help patients with cerebral palsy. This Powerpoint could help inform PTs about whether or not they wanted to implement strength training with patients. It could also serve as a guide for building a strength training treatment plan for those affected by cerebral palsy. I think having a plan like this available will help therapist get started giving patients the care that they need.