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Robyn Smith Department of Physiotherapy UFS 2012

FIT active habits for children with Cerebral palsy: Increasing levels of fitness and physical activity. Robyn Smith Department of Physiotherapy UFS 2012. background. Regular participation in physical activities is important for all children to stay fit and healthy.

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Robyn Smith Department of Physiotherapy UFS 2012

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  1. FIT active habits for children with Cerebral palsy:Increasing levels of fitness and physical activity Robyn Smith Department of Physiotherapy UFS 2012

  2. background • Regular participation in physical activities is important for all children to stay fit and healthy. • This is especially important for children with disabilities, who are often restricted in their activity options due to mobility problems. • Some of our children with CP show a deterioration in mobility, muscle strength and fitness related activities over their childhood years

  3. background • Current insights suggest that interventions for school-age children with CP should focus more on promoting an active lifestyle and increasing physical fitness. • Should this be changing our approach to intervention?

  4. What do we mean when we say exercise Programme? • Planned and structured activities involving repeated movement of skeletal muscles that result in energy expenditure and seeks to improve or maintain levels of physical fitness above the intensity required for activities of daily living • Activities of daily childhood life consist of well-balanced aerobic, anaerobic, and muscle strength components • Studies have shown that achieving an active lifestyle between 9-18 years determines prospects for an active lifestyle in adulthood Motivation of child & parental support and Involvement are KEY!

  5. Exercise for children with CP? • Exercise in children with CP has often been avoided because of the concern about the negative effect of such effort on muscle spasticity and children’s movement patterns. • Has been a shift in perspective in recent years about the use of exercise in children with CP. • Studies done to data evaluating the effect of exercise on children with CP reported no adverse effect on patterns of movement flexibility or spasticity. • Much research regarding exercise in this population still needs to be done (best practice, measuring etc)

  6. Why is exercise a concern and growing focus in the CP Population? • People with cerebral palsy are less physically active than their unimpaired peers (sedentary lifestyle) • Due to their sedentary lifestyle children with CP greater risk of developing secondary health problems including • cardiovascular disease, • osteoporosis, • obesity and • type II diabetes • pain • Inactivity can also contribute to social isolation and depression and poor self image/perception.

  7. Our interventions should therefore also focus on .... • Enhancing levels of physical activity , especially in school aged children with CP • There is preliminary evidence to suggest that structured exercise programmes increase habitual physical activity levels in children CP • Practicing and carryover of mobility related activities in daily environments is paramount.

  8. Benefits of exercise for children with CP • Numerous well documented benefits of exercise in this population: • Improves CVS fitness and endurance • Improves muscle strength and endurance • Improves balance/agility • Help control body weight • Improves flexibility and helps maintain ROM • Improves psychological wellbeing • Increases participation in individual and community activities • Improves bone density • Reduces risks of several chronic diseases

  9. Challenges for physiotherapists..... • Changing the mindset to our rehabilitation practices • Lack of a knowledge base regarding physical activity interventions and aspects of lifestyle, fitness and mobility in children with CP • Little research regarding the application and measurement of these parameters outside the laboratory setting • Physiotherapists knowledge and training regarding exercise fitness • Little knowledge regarding the effects of exercise programme’s in this population e.g. Overuse or musculoskeletal injuries

  10. Programme needs to be adapted child’s individual abilities and requirements Value of electronic games e.g. Wii

  11. FITT principles Can be used in developing a structures exercise programme FITT principle based training programme contain the Following components: • F Frequency • I Intensity • T Type of exercise • T Time These are principles that can be used in compiling a programme for a physically challenged child

  12. SO HOW DO GO ABOUT DEVELOPING AND IMPLEMENTING AN EXERCISE PROGRAMME FOR CHILDREN WITH PHYSICAL DISABILITIES ?

  13. UNIVERSAL EXERCISE PRINCIPLES COUNT......

  14. Frequency • Literature suggests that the child participate in a formal exercise programme 3-5 times per week is indicated • In studies done to date most of the children participated in formal exercise programmes between 2 and 4 times per week

  15. Intensity • Aerobic capacity at 60-75% maximal HR • Calculation max HR =220-age • Some data suggest even exercising at ≥ 40% of max.HR is beneficial

  16. Type of training • Individual or group circuit training in combination with specific exercises • Stations of relatively intense periods of activity e.g. Cycling followed by lower-impact stations e.g. Resistance training

  17. Conditioning programme Any exercise programme should commence with warm up. Duration of the war-up should be approx. 10- 15 Minutes and should include low impact dynamic movements using large muscle groups : • e.g. slow walking/ cycling on stationary bike or arm ergonomter • Can also include 2-5 min stretches of large muscle groups at the end of the warm up Warm up serves as preparation for the heightened level of physical activity to follow

  18. Conditioning programme Aerobic conditioning Aims improve CVS fitness & endurance Performed over longer periods time 20-30 minutes per session NB monitor HR of child and allow resting stations as well if indicated

  19. Conditioning programme Aerobic continued... • Can include any of the following exercises • Waking with walking frame counting number of step/ distance/ covered and time taken (speed) to increase progressively • Cycling on a stationary bicycle/arm ergonometer (resistance set and distance covered/time monitored) • Supported walking on treadmill ( speed/incline can be adjusted as progression) • Swimming • Endurance can even be improved by means of wheelchair rides of progressive lengths • Rowing machine • Arm ergomenter/static cycle

  20. Conditioning programme • Anaerobic capacity improved by activities require a sudden burst of energy over shorter periods. (≺30s) Can be Achieved by of task specific activities: • Running • Playing with ball • Cycling arm ergonometer/static cycle • MUST be at maximal intensity 15-20 seconds • Can progress by increasing duration and decreasing the rest period between spurts.

  21. Conditioning programme • Strength or resistance in order to improve strength training may include: • use of free weights e.g. ankle/wrist weight or dumbbells or • Weight machines • Functional strengthening e.g. loaded sit to stand; forward/lateral stepping, heel raises (start with body weight progress to a weighted vest) 3 sets 12 repetitions Two or three sets of 8-12 repetitions.

  22. Conditioning programme • Cool down allowing time to gradually reduce the level of activity and aims to improve /maintain flexibility: • self or assisted stretches of key muscle groups • May also include slow walking/cycling/wheeling

  23. Time/duration • Exercise programme to should be started gradually (progressive programme gradually increasing the frequency, duration and intensity of the training) and under the supervision of a physiotherapist. • Can start at 15 minutes and progressively increase to 45 minute sessions.

  24. Carry over into daily living • Encourage the child to become involved in sport for physically challenged and participation in community sporting events with family and friends • Heightened activities with daily living

  25. Health and safety considerations • Adequate hydration • Appropriate clothing and footwear • Safe execution of activities

  26. References • Bania, T. 2010. Increase habitual physical activity levels in people with cerebral palsy. ClinRehabil April 2011 vol. 25 no. 4 303-315 • United Cerebral Palsy (UCP). Exercise Principles and Guidelines for Persons with Cerebral Palsy and Neuromuscular Disorders • Verchuren, O; Ketelaar, M.; Takken, T.;Helders, P.J.M. & Gorter, J.M. 2007. Exercise programs for children with cerebral palsy. A systematic review. American journal of Physical Medicine and Rehabilitation • Van Wely,L; Becher, J.G.; Reinders-Messelink, H.A.; Lindeman, E.; Verchuren, O.Verheijden, J & Dallmeijer, A.J. 2010. Learn 2 Move 7-12 years: A randomised controlled trial on the effects of a physical activity stimulation program in children with cerebral palsy. BMC Pediatrics

  27. Rimmer, J.H. 2001. Physical fitness levels of persons with cerebral palsy. Developmental medicine & child neurology • How to exercise with Cerebral Palsy • WCPT 2011: focused symposia. Fit active habitds measuring fitness and physical activity in cerebral palsy

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