By Connie Janes
Strength training is becoming more common in children and adults with Cerebral Palsy as it is showing improvements in functionality.
Cerebral palsy is a brain injury that can happen invitro which is during pregnancy, during birth or shortly after the birth of a child. Within cerebral palsy there are very many different types and forms of the injury depending on what part of the brain has been affected. The injury hinders the brains’ ability to control the muscles of the body properly. It means that basic motor skills such as walking, sitting are affected and the child can find all these challenging. How much a child is affected depends completely on how much damage has occurred in the brain and what parts of the brain have been affected.
Typical signs of cerebral palsy in a baby are not hitting the milestones that most babies hit at certain ages. In someone with CP you might notice that they bum shuffle as opposed to crawling. And that they take longer to do things such a roll on to their tummy, sit themselves up and late with their walking. Depending on the level of severity does depend on whether the child will eventually pull themselves in to a standing position or not.
There are four types of cerebral palsy: Spastic, Dyskinetic, Ataxic and Mixed. Spastic cerebral palsy will have symptoms such as: involuntary limb movements, continuous muscle spasms and contractions, abnormal walking or scissor like walking gait, joint contractures, limited stretching abilities, flexion at the elbows, wrists and finders, poor coordination, and control of muscle movements.
A child with dyskinetic cerebral palsy has trouble making their muscles do what they want them to do. When a child is attempting to get movement in a particular way, they may experience the following: dystonia which is twisting and repeating movements that can be painful; Athetosis, which is slow, writhing movements or Chorea, irregular or abrupt movements.
Developmental signs of ataxic cerebral palsy may be that the child walks with feet spread far part, trouble bringing their hands together, unsteady gait and trouble grasping objects, trouble with repetitive movements, speech issues and slow eye movements.
Mixed cerebral palsy is a combination of different types of CP that affects the body, and this comes from multiple parts of the brain being injured.
Cerebral palsy can also affect different parts of the body. There are three ways that the body can be affected: quadriplegia which is when it affects the muscles in the whole body. Diplegia is when mainly the legs are affected and there are different levels of severity with this and hemiplegia when it is one side of the body that is affected.
How can S&C help someone with Cerebral palsy?
Someone with cerebral palsy is no different from someone without cerebral palsy in the sense that to improve movement in a sport you are likely going to need to increase strength to produce more power, improve balance to help stability and prevent injuries so just because someone has been diagnosed with something medically that can make physical movement more challenging doesn’t mean we think about that person in a different manner.
Doing strength training in someone with cerebral palsy can help reduce contracture symptoms which is when muscles and tendons shorten or tighten which can cause deformities. This is a secondary complication of cerebral palsy. Strength training also helps to improve the gait, function, and mobility of those with cerebral palsy.
To improve everyday activities such as walking, climbing stairs, lifting things, carrying objects etc we need to improve the strength in the muscles to be able to improve balance and the ability for the body to do the everyday things. So really S&C for someone with CP is the same as if you were coaching someone that was in a sports team, it’s just that there are slightly different outcome goals, but the process is just the same. We still progressively increase load; we still change things on a regular basis. The body still adapts to new stimulus.
As an S&C coach that specialises in cerebral palsy, I am not looking to see a performance improvement as such, I am looking to see a functional improvement. I want to know that after 12 months of working with me a child is finding it easier to walk. That maybe that can carry a glass of water from one place to the next. That they can pick things up with their hands if they weren’t previous able to do so or at least open and close their hands and have more control over their limbs. This is what is so important for me.
When working with a disability, you also must take into consideration that you are working with children and think about what a child will want to achieve. For example, they want to ride a bike, they want to ride a scooter, they want to be able to run with their friends. So, it’s using these goals to try and get them as close to this as they possibly can and about given them the confidence to push themselves.
Half the battle with CP is growing the confidence into belief. Obviously, I must be realistic within this and I can’t set false hope for things. But I am a strong believer that if you do put limitations on someone, they are less likely to be able to push the boundaries. The mind has a big part to play in the development of someone with cerebral palsy. And his has been proven because pretty much every child I work with has been told at some point that they won’t do things that they can now do.
Being Creative
The big things that I know that I need to do when working with a child with cerebral palsy is that if they are affected in their legs then I need to improve their strength, balance, and coordination. To improve walking gait, I know that their coordination needs to improve, their balance needs to improve, and their strength needs to improve. I know that to improve their balance I need to improve the strength in their legs, so they feel confident lifting one leg off the floor. I know to improve their balance I need to improve their core stability and core strength. So, this is the basis for every programme that I do with a child with cerebral palsy.
If they are affected in their upper body, I need them to weight bare through their arms because I need to strengthen the arms. a child with cerebral palsy that affects one side of their body (hemiplegia) might completely favour the arm that isn’t affected meaning you get an even bigger disparity in strength.
With those things in mind and the other thought that I work predominantly with children under10 I had to start coming up with some ideas that weren’t going to bore the children but was also going to get results. Once they get a bit older, I tend to start doing some of the traditional S&C movements and even as they are younger, I try and hide them in the activities or games that we play, however, my current toolbox for training is, boxing, balloon tennis, wheelbarrow, climbing, jumping off of things, jumping over things.
I also have special ‘fitness dice’ that I use with the kids where the dice will tell them what exercise they are doing, could be push ups could be squats but to them it’s a game. I’ve recently introduced the use of blaze pods as well which is a fantastic tool to get kids engaged in doing different physical therapy exercises but also gets them to compete with me whilst they are using them.
Boxing is something that I’ve noticed has an all-round improvement on children with CP. I’m introducing coordination, core strength, and arm strengthening exercises. They aren’t strength in the same way as us talking about a 1 Rep-Max, but they are improving the muscles strength with regular training. It’s also fun for them.
Another big focus is jumping. If the kids can stand unaided, then a big part of their training is learning to jump. As an S&C coach I make sure I teach how to jump and land in any programme. Sport related you need to be able to explode and accept load from high force positions so it’s important to know the mechanics of jumping and landing. So, I take that from my S&C knowledge and use that for training kids with CP. This is majorly important because not only is it a good tool to increase power in their legs, but it also gives them confidence to jump or to get down off something.
Take aways
There is still a lot to learn about cerebral palsy and how we can improve quality of life for children with the disability. As medicine improves and more children are surviving traumatic births there is an increase of children that are diagnosed, which is the be expected. Now as practitioners we need to come up with ideas, research new ideas and experiment with ideas to try and make the lives of those affected as independent as possible.