Dr. Saleh AL-Oraibi, PhD, MCSP, Associate professor/ Physiotherapy and rehabilitation. so55@hu.edu.jo soraibi@hotmail.c

1. Aging and cerebral palsyEvidence from research outcomes Dr. Saleh AL-Oraibi, PhD, MCSP, Associate professor/ Physiotherapy and rehabilitation. so55@hu.edu.jo soraibi@hotmail.com

2. Presentation overview • Background information about ageing for people with cerebral palsy(PWCP) • Aims and objectives • Methods used to collect information • Consequences of ageing process for PWCP • Strategies to reduce these consequences • Conclusion and recommendations

3. Background information • Recent research indicates that PWCP age early and they experience an increase pain, muscle and joint fatigue, depression and loneliness, and feelings of isolation as they age. • Families of PWCP can also experience a range of overwhelming problems and consequences following ageing process. • However, research suggests that people with cerebral palsy and their families are in need for information about cerebral palsy and its ageing process. • The needs for information have been identified in studies in developed countries but it is even more urgent for PWCP and their families in Arab region because the day-to-day responsibility of caring for these individuals remains largely with their families.

4. Aim and objectives • The aim of this systemic review was to look at the research current evidence related to CP and ageing process and its consequences. • The objectives was to: • provide people with cerebral palsy and their families with information to help them manage the consequences of CP ageing process. • To provide also important information for health professional who work with them.

5. Methods • The search was done in different data bases such as AMED, Medline and CINHAL to identify research articles related to CP ageing process[11] • Then a review was performed to summarize findings of intervention studies and their recommendations to reduce PWCP ageing consequences. • All studies were conducted in developed countries with limited research in developing countries including Arab region.

6. Consequences of CP ageing process

7. Physical consequences • They Lose some of the mobility they gained as children(75% by age 25) • Early onset Osteoarthritis (27%) • An increase in fatigue • Falling accidents (Elevated fracture rates ) • Increased involuntary movements • Joints and back pain • Increase in muscle spasms • Bone loss and early osteoporosis • Increase in joint contractures and deformities and Postural problems

8. Social consequences

9. Psychological consequences

10. Other consequences Negative effects from the long term use of medications. Gastro intestinal problems. Decline in dental health from poor dental maintenance in youth. Weakness caused by poor nutrition intake

11. Non pathologic aging process • Loss of hearing • Loss of visual acuity • social isolation • confusion • apparent loss of skill.

12. Can we prevent and reduce the impact of ageing for people with cerebral palsy

13. Recommendation to reduce the impact of Ageing for PWCP consequences

14. Exercises & Physical Therapy • Strength training improve physical function of adult with cerebral palsy (Taylor, et al., 2004). • Increasing physical function: for example, community Gym, sport, swimming, horse riding etc • Studies have also shown that adults that had a large amount of childhood physical therapy (4 to 5 times a week) over a long period of time (4 plus years) have less ageing consequences.

15. Socializing • Socializing plays a big part in everyone's life, whether its at school, work, or at home with their family.

16. Nutrition • Nutrition, which is important in everyone’s life, is especially important in a person dealing with aging and cerebral palsy. • A proper diet including foods high in fiber and low in fat is preferred. • A proper diet will help prevent constipation and weight gain, while increasing energy levels.

17. Proper management and care • Seating and posture with help of occupational therapy • Spinal monitoring • Monitoring of stiffness and contractures • Maintaining range of joint movement • Upright walking posture and persistence with walking • Maintaining rehabilitation program • Family education and involvemnt

18. Conclusion • This review paper highlight a number of important issues related to cerebral palsy ageing process and provides guidelines for people with cerebral palsy and their families of how to cope with the sequences of ageing and will allow parents to play their role effectively. • These guidelines will also inform policy makers, health and social professionals, service providers with important information to help them dealing with their clients ageing process issues. • This review shows that exercises, socialising and a proper diet will reduce the effects of ageing process for PWCP.

19. Recommendations • Families and PWCP must be given appropriate information about ageing process. • This information should be tailored to the needs of each individual. • Other professionals, including rehabilitation nurses, social workers and psychologists need to be involved in helping PWCP and their families in the community.

20. Refernces • Balandin & Morgan, 1997. Balandin, S., & Morgan, J. (1997). Adults with cerebral palsy: What’s happening? Journal of Intellectual and Developmental Disability, 22, 109–124. • Crichton, J. U., Mackinnon, M., & White, C. P. (1995). The life expectancy of persons with cerebral palsy. Developmental Medicine and Child Neurology, 37, 567–576. • Janicki, M. P. (1989). Aging, cerebral palsy, and older persons with mental retardation. Australia and New Zealand Journal of Developmental Disabilities, 15, 311–320. • Lennox, N., Cook, A., & Rawicki, H. B. (1997b). Adults with cerebral palsy: Getting off on the right foot. Modern Medicine of Australia, 85–96. • Kailes, J. I. (1993). Aging with a disability: Educating myself. The Networker, 7(1), 6–9. • Murphy, K. P., Molnar, G. E., & Lankasky, K. (1995). Medical and functional status of adults with cerebral palsy. Developmental Medicine and Child Neurology, 37, 1075–1084. • Overeynder, J. (1994). Aging and cerebral palsy: Pathways to successful • aging. The UCPA Networker, 7, 2–4. • Overeynder, J., Turk, M., Dalton, A. J., & Janicki, M. P. (1992). I’m worried about the future: The aging of adults with cerebral palsy. Albany, NY: New York State Developmental Disabilities Planning Council. • Schwartz, B. (1994). Aging for persons with cerebral palsy. CommunicatingTogether, 12(3), 14–15. • Turk, M. A., Overeynder, J. C., & Janicki, M. P. (Eds.). (1995). Uncertain future—Aging and cerebral palsy: Clinical concerns. • Willner, L., & Dunning, D. (1993). Ageing with cerebral palsy. London