Cerebral palsy is defined as non-progressive lesions or damages in the brain at or before birth, leading to impairments in movement and posture.

Movement and Strength of Children with Cerebral Palsy

Movement and Strength of Children with Cerebral Palsy
Cerebral palsy is defined as non-progressive lesions or damage in the brain at
or before birth, leading to impairments in movement and posture.

These impairments vary from person to person, but the majority of children with
cerebral palsy experience differences in muscle strength which can lead to many
functional challenges throughout their lives.





As discussed in the article above, strength training in children with cerebral
palsy has been shown to be beneficial particularly in improving their motor
activity. It can be confusing for caregivers to objectively determine what type
and frequency of strength training activity would be helpful. Evaluations such
as the Pediatric Functional Muscle Test can be useful for clinicians and
therapists for in-the-moment information, but provides limited information and
applications for continued training.

It is important to know the basic principles of strength training with children
with cerebral palsy before starting any program.



Strength training for children with cerebral palsy
 1. Repetition!
    Children with cerebral palsy often have difficulty activating certain muscle
    groups. In order to effectively strengthen these muscle groups, training
    should focus on repetition of postures or activities that encourage movement
    in these areas.
    
    
 2. Find the right tools!
    In order for a training program to be effective the child needs to be able
    to understand and engage in the instructed movements.
    
    
 3. Positioning!
    Engaging in the activity with good posture will enhance the effectiveness of
    the training
    
    
 4. Adaptation!
    Make sure the training activity is an appropriate amount of challenge for
    the child's abilities. Remove too-complex elements or add challenge to
    too-easy elements to ensure they stay motivated.
    
    
 5. Engagement!
    Training that is relevant to the child's interests will have better
    long-term effects. Ensure they have a say in their program, either catering
    a routine to include relevant personal touches or letting the child pick the
    day's activity are surefire strategies.
    
    





Goals of strength training for CP
Not only can strength training activities for children with cerebral palsy
strengthen muscle groups, these effects can translate into improved function in
daily life. Stronger and more coordinated muscles may lend to greater
independence in self-care skills and feelings of capability and self-confidence.

The benefits of strengthening for pediatric CP are clear. Look to your
rehabilitation team for additional tips to get started on an effective exercise
program.



Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of
strength-training programs for people with cerebral palsy. Arch Phys Med
Rehabil. 2002;83(8):1157-1164. doi:10.1053/apmr.2002.34286

Cerebral Palsy Rehab

This classification system is useful for determining overarching areas of deficit, but can leave much to be desired when identifying a kiddos level of ...

Understanding Cerebral Palsy Classification levels


Children with cerebral palsy may be classified as Diplegic, Hemiplegic,
Quadriplegic, Dyskinetic, Ataxic or a mixture of these depending on the
presentation of their symptoms.

This classification system is useful for determining overarching areas of
deficit, but can leave much to be desired when identifying a kiddos level of
functional capacity or severity of disability.

While these traditional markers continue to be the primary method of
classification used in the medical field, there is an additional system that can
provide a more robust picture of the kiddo as a whole.

The Gross Motor Function Classification System (GMFCS) uses 5 levels to classify
a child’s individual motor abilities through an analysis of functional mobility
or more simply, how they get from place to place.


5 Levels of Cerebral Palsy
<Level 1>

Level 1 includes children who have no restraints when walking. They can ambulate
freely without instability. Typically children in this level do not wear any
assistive devices.


<Level 2>

Level 2 includes children who can walk without assistance but may have some
difficulty at times. Typically these kiddos cannot jump or balance on one foot,
may fall frequently and/or need to hold onto railings when walking up stairs or
over curbs.


<Level 3>

Level 3 includes children who need to use an assistive device to walk upright.
These kiddos can walk in certain environments for reduced distances by self
directing the use of devices such as revere walkers or forearm crutches. For
longer distances children in level 3 will used wheeled mobility and can often
self propel their chair.


<Level 4>

Level 4 includes children who require external assistance in order to get
around. They may use a wheelchair or a walker with significant help and support
to compensate for lack of speed and/or stability. The child on the right is
using a device called a Gait trainer, which provides trunk support for those who
are unable to fully support themselves using a typical walker..


<Level 5>

Level 5 includes children who require the assistance of a guardian for all
movements. These kiddos often cannot support their head and trunk while seated
and may utilize wheelchair positioning devices such as head rests and lateral
supports.


Sometimes, the distinctions between different levels can be unclear. Kiddos can
have varying abilities, depending on the day. The best way to determine which
level is the best fit is to think of how the child gets around most of the time,
not just their best performance. Also, although GMFCS levels may seem to focus
on lower body function, understand that many of these assistive devices require
the use of arms and hands as well.

Seek the advice of your medical or therapy team if you are not sure what GMFCS
level applies to your child or if a treatment plan is recommended to maximize
their day-to-day function.

Further Reading
Fun Outdoor Activities for Your Child With Cerebral Palsy
[https://evergreenhhc.com/pediatric-health-care-denver/fun-physical-activities-for-your-child-with-cerebral-palsy/]
Indoor Sensory Activities for Your Child With Cerebral Palsy
[http://jldtherapy.com/5-sensory-activities-to-do-at-home-with-cerebral-palsy/]
Cerebral Palsy Research Network [https://cprn.org/]