# Exercise as it relates to Disease/Exercise and cerebral palsy
## What is Cerebral Palsy?

Cerebral Palsy is an umbrella term given to a group of disorders that affect movement[1]. It is a physical disability caused by an abnormality or non-progressive lesion which has damaged the developing brain, usually prior to birth and although it is a permanent condition it is not unchanging[1].

## Possible Causes

   * Complications at birth, asphyxia (lack of oxygen)
   * Combination of events causing injury to a babies developing brain[1]
   * In most cases, brain damage occurs in the uterus or before 1 month old[1]
   * Stroke most common cause in babies after 1 month old[1]
   * Stroke occurs spontaneously or from surgical or heart problems[1]

## Diagnosis

Cerebral Palsy is often very difficult to diagnose and generally requires repeated tests before it can be officially diagnosed[1]. Parents are usually the ones who first become aware that something is wrong when their child is not reaching the established developmental milestones. Once alerted doctors will take and carefully examine a full medical history of the child and then monitor the child's movements and muscle tone. Observation of the babies general movements, whether they have very relaxed, loose muscle or tight, stiff muscle and if they have any postural preferences will help with the diagnosis. Once this has been done the child must be monitored to insure it is not a more serious progressive disorder before the diagnosis of Cerebral Palsy can be made.

## Prevention Methods

Currently there is no total way to prevent or cure cerebral palsy[1], however two methods have been developed to reduce the severity of cerebral palsy:
   * Magnesium Sulphate: given to pregnant women when they are at risk of having a pre-term birth[1]. This can help protect the unborn child from brain damage which can lead to cerebral palsy[1].
   * Cooling Cap: This is used when new born babies that have suffered brain damage, due to lack of oxygen before birth[1]. The cooling cap aims to reduce the impact of the brain damage[1].

## Treatment

There is no clear treatment for cerebral palsy, however research development in brain plasticity has given hope to those with the condition[1]. The brain's plasticity allows for injured areas of the brain to be taken over by another section, by compensating for the injured area[1]. In the future it is hopeful that gene and stem cell therapy may be used, even before a baby is born to repair damaged cells of the brain that would generally lead to cerebral palsy[1].

## Recommendations
### Physical Therapy

Studies have shown that resistive exercises could be positive in muscle strengthening in cases where muscle weakness causes dysfunction. Training was found to increase strength and improve motor activity in individuals with cerebral palsy.

### Resistance Exercises

Resistance training may aid in the amount of knee crouch during gait by focusing on strengthening the quadriceps. A study showed that children with cerebral palsy were significantly weaker in the quadriceps and hamstrings than those without. By following a training program, the quadriceps strength was improved at all three angles of knee flexion as a result of the resistance training. Quadricpes weakness was shown to be major contributor in crouch gait, and by strengthening the quadrcipes with resistive exercises may contribute to the treatment of cerebral palsy[4].
In order to have normal motor control, a certain amount of strength must be present, individuals with cerebral palsy lack this strength and as a result, their motor function is affected. Increasing strength on the lower limbs was shown to positively affects gait and increase free walking velocity. Continuing a training program focusing on strength in the lower limbs would be beneficial to improving walking cadence and velocity[5]. A strength training program could enhance the motor function of those with cerebral palsy, focusing on the larger muscle groups first, such as the quadriceps and hamstrings to enahance the ability to walk.

### Aquatic Exercises

Aquatic exercises may be very beneficial for individuals with cerebral palsy. This is due to the buoyancy of the water minimising the influence of gravity and providing more postural support, as well as reducing the levels of joint loading and impact on the joints, providing a gentler environment for individuals with cerebral palsy. The added benefit of aquatic exercises is the resistive forces of buoyancy and viscous drag, giving a variety of aerobic and strengthening activities that can be modified to accommodate different levels of motor function to people with cerebral palsy. Although there are positive elements to aquatic exercise for people with cerebral palsy, there are factors that must be considered before exercise can begin[6]. They are:
   * Adequate intensity, duration, and frequency (this will depend on this severity of the condition)[6]
   * Will a group environment be more beneficial than training individually[6]
   * Pool environment is suitable and safe[6]

## Safety Considerations

People with Cerebral Palsy are highly susceptible to falls and in some cases seizures. Take these points into consideration while exercising:
   * Ensure there is adequate support available in the area such as hand rails or walkers
   * Remove any objects from the area which may present as a hazards, such as benches and weights
   * Take extra care if walking through wet, slippery areas such as around a pool

## Further reading

      * Cerebral Palsy Alliance - www.cerebralpalsy.org.au
      * Cerebral Palsy Australia - www.cpaustralia.com.au
      * My Child Without Limits - www.mychildwithoutlimits.org
      * The Centre for Cerebral Palsy - www.tccp.com.au

## References

* ↑ Cerebral Palsy Alliance; date visited 20/10/12; http://www.cerebralpalsy.org.au/
* ↑ How is Cerebral Palsy Diagnosed?, last updated 09/2009, viewed 17/10/12, http://www.mychildwithoutlimits.org/?page_id=04AECCDA-C111-5304-45D35BF814B7F724&r=1
* ↑ K. W. Krigger, M.D, M.E.D; Cerebral Palsy: An Overview
* ↑ D. L. Damiano, C. L. Vaughan, M. E. Abel; Muscle response to heavy resistance exercise in children with spastic cerebral palsy
* ↑ D. L. Damiano, M. F. Abel; 1998; Functional Outcomes of strength training in spastic cerebral palsy
* ↑ M. Kelly, J. Darrah; 2007; Aquatic Exercise for Children with Cerebral Palsy