CEREBRAL PALSY

JASMINE OVIEDO
 GAIT
● Population-based studies show that age at first walking is delayed
● There is a decrease in gait function and pattern through adolescence and adulthood
expressed as a decrease in gait velocity, stride length, and sagittal joint excursions over
time.
● Some surveys of adults with CP also show decreased walking ability with age.
● What interferes with normal gait pattern?
○ Spasticity
○ Muscle Contractures, bony deformities
○ Loss of selective motor control
○ Muscle weakness
● Muscle Strength Training to Improve Gait Function in Children with CP
○ 16 participants (ages 10-15), GMFCS Level I and II
○ Muscle strength was measured by myometer
○ Increased muscle strength improved gait function in the participants
(Andersson et. al, 2007) (Eek et. al, 2008)
 POSTURAL CONTROL
● The injury of the brain in individuals with CP leads to deficits in postural, motor, and perceptual networks
● The deficit in motor process in children with CP, which appears in the form of spasticity or muscle weakness,
causes deficits in postural control.
● Abd El-Nabie et. al studies the relation of trunk imbalance, lateral deviation of the spine and pelvic tilt with
postural control in children with diplegia
● 77 children with diplegic CP ages 6-8, GMFCS II
● Pediatric balance scale (PBS) was used to assess postural control
○ Sit to stand, stand to sit, transfers, standing unsupported, standing with eyes closed, standing with
feet together, turning 360 degrees, retrieving object from floor, etc.
● This study found a moderate negative correlation of trunk imbalance, lateral deviation of the spine, and
pelvic tilt with postural control
● Weakness of the trunk muscles cause trunk imbalance and dysfunction of postural control

(Abd El-Nabie et. al, 2019)

 BALANCE

● Individuals with CP experience difficulties in sensory processing and praxis

● Good sensory integration leads to balance
● Rani et. al assessed the effectiveness of vestibular stimulation on balance using swing therapy in
children with hypotonic CP
● Swing therapy helps re-organize the special senses including attentiveness, contact, vibration, and
sight.
● This sensory therapy gives assistance to frame one’s sense of balance
● Swing therapy was given for 8 weeks on alternate days for 15 minutes to 52 patients (GMFCS II)
● Forward and backward swings stimulated the utricle (responsible for linear balance)
● Sideways swings stimulated the saccule (responsible for rotating balance)
● This study found that swing therapy proved to be effective in improving balance in children with
hypotonic CP (when integrated with other conventional methods of rehabilitation)
 WEIGHT STATUS
● Individuals with CP (with severe motor impairments), commonly have feeding difficulties and swallowing problems
resulting in malnutrition and poor growth
● Finbraten assessed the body composition of children with CP
○ 52 children (20 females, 32 males)
○ 8 had feeding difficulties
○ 5 had a gastrostomy tube
● 38% were in the normal BMI range, 23% were overweight , 13% were obese

● Body composition in children with CP is different. They tend to have less muscle volume and wither more or less fat
free mess.
○ Due to trophic changes in muscle structure and the associated loss of motor function.
● Breij et. al states that children with spastic CP could be classified as “healthy” based on MBI and classified as
“unhealthy” based on fat mass percentage
○ BMI is not appropriate as an indicator for body composition
● BMI is not a suitable measure of fat mass in children with CP
● Bioelectrical impedance analysis (BIA) is preferred for individuals with CP

Finbraten et. al, 2015 Breij et. al, 2023

 PHYSICAL ACTIVITY

● Adolescents and adults with CP are less physically active than their typically
developed peers
● About 40% of adults with CP report pain regularly
● Physical Activity in Adolescents and Young Adults with CP
○ 71 participants
○ Data was collected at 14-16 years old, 17-18 years old, and 19-22 years of age.
○ 65% indicated that they participated in physical activity
○ Only 56% on a regular basis (Once a week)
○ Differences in physical activity levels were seen between levels of GMFCS

(Waltersson et. al, 2017)

Physical Activity- University of Michigan Exercise Guidelines for CP
Musculoskeletal

● Muscle weakness is a major factor affecting functional ability in individuals with CP

● Individuals with CP often experience spasticity, making it difficult move or walk
smoothly.
● Aquatic exercises have become popular for individuals with CP, because it takes away
the pull of gravity
● Thorpe et. al investigated the effects of an aquatic resistive exercise program on
ambulatory children with CP.
● They found that an aquatic exercise program increased overall lower extremity muscle
strength and gait velocity
 Cardiorespiratory

● Weakness in individuals with CP prohibits participation in vigorous cardiovascular conditioning programs.

● Kusano et. al reported on the measurement of physical fitness of adult males with CP with various motor
dysfunction using an arm ergometer
○ CP group: 11 ADL-independent adults. Spastic (6), athetoid (3), and mixed (2)
○ Control: 9 able-bodied men
● Results showed no significant difference in heart rate, minute ventilation, or oxygen consumption at rest
between CP group and control group.
● Mean values in peak HR we significantly lower in CP group
○ CP: 152.7 beats/ min
○ Control: 175.8 beats/min
● Mean values in physical work capacity were significantly lower in CP group
○ CP: 45.8 watts
○ Control: 126 watts
● This study concluded that peak physical work capacity of subjects with CP was significantly lower than that
of able-bodied people and their work efficiency was about 50% lower

Tobitumatsu et. al, 1998

 References

● Abd El-Nabie, W. A. E.-H., & Saleh, M. S. M. (2019). Trunk and pelvic alignment in relation to postural control in children with cerebral palsy.
Journal of Back & Musculoskeletal Rehabilitation, 32(1), 125–130. https://doi-org.ezp.twu.edu/10.3233/BMR-181212
● Andersson, C. and Mattsson, E. (2001), Adults with cerebral palsy: a survey describing problems, needs, and resources, with special emphasis on
locomotion. Developmental Medicine & Child Neurology, 43: 76-82. https://doi.org/10.1111/j.1469-8749.2001.tb00719.x
● Breij, L. M., van de Ven, R. A. H., Hulst, R. Y., Smorenburg, A. R. P., Gorter, J. W., & Verschuren, O. W. (2023). Body mass index is not suitable for
assessing body composition in children with spastic cerebral palsy. Disability and rehabilitation, 1–6. Advance online publication.
https://doi.org/10.1080/09638288.2023.2167007
● Finbråten, A. K., Martins, C., Andersen, G. L., Skranes, J., Brannsether, B., Júlíusson, P. B., Syversen, U., Stevenson, R. D., & Vik, T. (2015).
Assessment of body composition in children with cerebral palsy: a cross-sectional study in Norway. Developmental medicine and child neurology,
57(9), 858–864. https://doi.org/10.1111/dmcn.12752
● Rani, M., Waqas, S., Asim, H. M., Tariq, M., & Javaid, A. (2022). Effectiveness of Vestibular Stimulation on Balance Using Swing Therapy in Children
with Hypotonic Cerebral Palsy. Annals of King Edward Medical University, 28(1), 64–68.
● Thorpe DE, Reilly MA. The effect of an aquatic resistive exercise program on ambulatory children with cerebral palsy. Aquatic physical therapy,
2005; 13-22
● Tobimatsu, Y., Nakamura, R., Kusano, S., & Iwasaki, Y. (1998). Cardiorespiratory endurance in people with cerebral palsy measured using an arm
ergometer. Archives of physical medicine and rehabilitation, 79(8), 991–993. https://doi.org/10.1016/s0003-9993(98)90099-5
● Waltersson, L., & Rodby-Bousquet, E. (2017). Physical Activity in Adolescents and Young Adults with Cerebral Palsy. BioMed research international,
2017, 8080473. https://doi.org/10.1155/2017/8080473