Early, aggressive treatment of cerebral palsy is the best way to prevent loss of functional ability for those suffering from it. After having researched different methods of treating cerebral palsy, I strongly recommend prepubescent resistance training to improve your child's quality of life.
Until recently, prior theories had doctors and therapists believing that strength training in spastic muscles would further increase spasticity, and would have no positive consequences. After researching several online databases on www.pubmed.com, I did not come across any studies to support the theory that spasticity increases because of strength training. However, I did find research published in the June 2001 edition of the Physical Therapy Journal that contains a study that refutes such assertions. EG Fowler, an assistant professor in the UCLA Department of Orthopaedic Surgery, and her colleagues Ho, Nwigwe, Dory, and Dr. Fowler studied twenty-four subjects with spastic diplegia involving the quadriceps femoris muscles, and twelve subjects without any neurological impairment. The study included measuring the subjects range of motion prior to and immediately after resistance training. Their study concluded that resistance training had no negative effect on the spasticity of people with cerebral palsy.
Because I have not found any evidence suggesting that there are negative consequences due to resistance training does not mean that none exist. This blog has been built for the purpose of open, honest discussion between people who truly want to find the best methods of care for children suffering from cerebral palsy. I challenge you, the educated public, to find research either supporting or contradicting my theory. I hope to read your responses soon!
Steven Buehring
yep, that's me!
About Me
- Steven Buehring
- Boston, Massachusetts, United States
- - I grew up on Long Island - My hobbies include tennis, poker, and movies - I am currently a student at Northeastern University - I will graduate with a doctorate in physical therapy in the year 2010
4 comments:
I understand, and respect the concept of trying to reduce the need for invasive surgery, but I do not believe that weight training will be helpful for children. In a web article I found at http://www.gssiweb.com/Article_Detail, doctor Blimke mentions that there are not any significant gains in muscular hypertrophy in preadolescents, and that there is an increased risk of musculoskeletal deformity associated with weight training.
Improper technique, lack of understanding, and increased chance of overloading can all lead to serious injury in a preadolescent who is subjected to weight training regimens. Putting too much stress on the knee, as with a knee extension exercise, could permanently damage the epiphyseal plate of the proximal end of the tibia or distal end of the femur. This risk is particularly pertinent to children with cerebral palsy because as you mentioned in your post, quadriceps femoris training would be prescribed to improve gait patterns. In addition to increased bodily risk, there is a misconception that reducing spasticity is necessary for every child who has cerebral palsy.
Spasticity, although deleterious in most cases, can be useful in some circumstances. For a boy who has severe muscle weakness and does not have the option of proper treatment, spasticity can act as a postural support mechanism, allowing him to move and complete tasks at a functional level. As reported in an article in the Indian Journal of Pediatrics:
"Reduction of spasticity is only one of the many facets of the overall management of motor disorders of cerebral palsy. While in some children spasticity may interfere with motor function, in others it may in fact be useful to maintain posture and the capacity to ambulate." (Patel & Soyode, 2005, p.869)
In many cases, the risks of implementing a resistance training regimen outweigh the potential benefits that might come out of the program. It is my opinion that current therapies available, excluding weigh training, are the more appropriate course of action.
It is true that there is a greater risk for injury, but that is only if the child is not supervised. The author of the article you read online, Blimke, also concluded on http://www.wesnet.com/kohl/restrain.htm that weight training is beneficial to preadolescent’s who do not try to push themselves to their upper limits. In specific regard to preadolescent injury Blimke summarizes that, "In a recent review of the literature, Mazur et al. (1993) noted that most cases of injuries caused by weightlifting exercises in children and adolescents (10 to 19 years of age) were the result of accidents in the home, not the result of supervised weight-training exercises or competitive weightlifting." He added that, "They also concluded that there was no increased risk of injury in prepubescent athletes participating in carefully supervised strength-training programs."
I understand that not all children benefit from reducing spasticity, and that is why doctors and physical therapists who can analyze the situation exist. It is important to realize that children who can benefit through improved neuromuscular mechanisms as a result of strength training routines will be supervised by qualified individuals in a safe environment.
I can see where both of you are coming from, but Steve, if Sandra is correct and there is more risk associated with prepubescent weight training, why not try an alternative? What about positional therapy, selective dorsal rhizotomy, or botulin injections?
Positional therapy, most commonly advocated by therapists who have trained in the Bobath technique, is an effective method of preventing contractures. By using activities of daily living that place patients in positions opposite their spasticity, contractures are prevented from forming. The reason I advocate weight training over this, though, is because positional therapy does not treat the underlying cause of some gait deformities that can form. Mainly, this underlying cause is weakness.
In a rebuke to the theory Bobath created, that using resistance training would increase spasticity by agitating the reflex system, Damiano, an assistant professor of orthopaedics at the University of Virginia, and his colleagues Kelly, and Vaughan concluded that heavy resistance training is beneficial in the areas of crouching and the quality of the subject's gait. Damiano explains in his introduction that, "Evidence of imbalanced muscle function in spastic diplegic gait included exaggerated hip flexion, adduction, and medial (internal) rotation in stance; excessive knee flexion or 'crouch' during stance; and increased ankle equinus." Daminao's interpretation of the study results in the conclusion that another reason people afflicted with Cerebral Palsy have altered gait, in addition to spasticity, is muscular imbalance. This finding substantiates that Bobath was incorrect to reject resistance training because it is in fact a successful treatment option for the reduction of spasticity and altered gait. If you want to see the study for yourself, I have included a link in my "supporting research" section at the bottom of the page.
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