IMPACT OF COMPLEX MOTOR EXERCISE TO CEREBRAL PALSY PATIENTS

Abstract

Cerebral palsy (CP) is permanent disorder affecting body posture and movement in various areas of children's health status. Four original scientific papers have been the subject of research in this paper. All the above mentioned papers have answered the requirements concerning the subject matter and the aim of this paper. Aim of this paper is to establish impact of programming to CP patients. Method used was the selection of papers issued from 2003 to 2011. We drew the conclusion that physical activities of CP patients are at very low level due to the specific nature of the medical condition itself. Regular, professionally guided and persistent programmed agents and procedures with CP patients result in significant improvements. Various issues, especially in the adolescent age, may be addressed if problems uprising from the condition are addressed at early stage, in early childhood. Improvement can be expected in higher motivation, better functioning, greater physical stability, balance, coordination and other significant factors.

Full text

Professional article SPORT AND HEALTH Vol X (2015) 2: 82-88
Bojan Bjelica1, Radomir Pržulj1
1Faculty of Physical Education and Sport, University in East Sarajevo
UDK: 616.8-009.11:796.012.1
Doi:
IMPACT OF COMPLEX MOTOR EXERCISE TO CEREBRAL PALSY
PATIENTS
Summary
Cerebral palsy (CP) is permanent disorder affecting body posture and movement in
various areas of children’s health status. Four original scientific papers have been the subject of
research in this paper. All the above mentioned papers have answered the requirements
concerning the subject matter and the aim of this paper. Aim of this paper is to establish impact
of programming to CP patients. Method used was the selection of papers issued from 2003 to
2011. We drew the conclusion that physical activities of CP patients are at very low level due to
the specific nature of the medical condition itself. Regular, professionally guided and persistent
programmed agents and procedures with CP patients result in significant improvements. Various
issues, especially in the adolescent age, may be addressed if problems uprising from the
condition are addressed at early stage, in early childhood. Improvement can be expected in
higher motivation, better functioning, greater physical stability, balance, coordination and other
significant factors.
Кey words: cerebral palsy, physical activity, motor disorder, lesion
1. INTRODUCTION
Cerebral palsy (CP) is a term which explains a group of syndromes of motor disorder of
non-progressive nature which are a consequence of lesion or brain anomaly in early stages of
development (Dormans et al., 2000). The condition is primarily connected to changes in posture
and movement but it is also followed by additional numerous secondary issues which greatly
affect health status and quality of life (Koman et al., 2004). There are certain components of CP
patients’ health status which can be positively affected by physical activity (Heimer &
Duraković, 1999).
Research has shown that people with CP must maintain higher level of physical
preparedness than healthy population in order to postpone deterioration of functional ability of
organism connected to aging and consequences of primary damage to the organism (Rimmer,
2001). Planned physical activity aimed at increasing functional ability at early age lead to
increase in oxygen intake and therefore improvement in stamina of the CP patients (Shinohara,
Suzuki, Oba, Kawasumi, et al., 2002). Programmed exercise aimed at strengthening the muscles
of lower extremities result in extraordinary improvement in CP patients’ condition and achieved
results are lasting a long time (Blundell, Shepherd, Dean, et al., 2003). Such and similar
SCIENTIFIC CRITICISM, CONTROVERSY

Professional article SPORT AND HEALTH Vol X (2015) 2: 82-88
programmes, using extra weight over specific time intervals lead to gaining better strength of
lower extremities of CP patients (Unger, Faure, Frieg, 2006) as well as the increase of muscle
tonus which provides better mobility of children with CP and which might have positive impact
to leg muscles (Lee & Chon, 2013). Advantages for people who maintain their physical functions
a higher level and who fight the problems caused by CP are numerous ЦП (Rimmer, 2007).
Proportion of improvement which can be achieved by people who perform certain forms of
self-guided programmes for strength development and muscle engagement, compared to people
who spend time in regular daily activities, is evident in fact that it is possible to achieve inhibited
results in six weeks with CP patients. Such effects remain positive after strength trainings in the
future (Dodd, Taylor, Graham, 2004).
Recent developments in the field of technology and methods for aiding, especially CP
patients, are using games of ‘virtual reality’ which has the aim to engage as many body parts as
possible into movement and lead to strengthening specific muscles and amplitude of movement
which is desirable in such condition (Li, 2007).
Regular, team planned and programmed physical activity can have significant impact to
changes of morphological, muscle, motor and cardio-vascular functions of healthy fitness of
children with CP (Klajić et al., 2007). For better understanding, we provided classification and
main causes of the disease in Table 1.
Table 1.
Classification and main causes
Motoric syndrome
Neuropathology
Main causes
Spastic diplegia
Perventicular leucolamacia
Prematurity
ischemia
infection
endocrine/metabolic causes
Spastic tetraplegia
PVL multicystic encefalopathy
Ischemia
infection
endocrine/metabolic causes.
genetic
Hemiplegia
Brain infarction
coagualation disorder
infection
genetic
Extrapyramidal
(aletoid/dyskinetic)
Basal ganglia
Putamen
Kernicterus
Talamus
Asphyxiation
mitochondrial disorder
genetic
2. МЕТHOD
Research data for the purpose of this research was collected via electronic databases
PubMed, Scholar Google and DOAJ. Search of publications was limited to period from 2003 to
2011. In database search key words used were: cerebral palsy, physical activity, motor disorders,
and lesions. Research titles, abstracts and entire papers found were then read and analyzed. In
order to accept any of the found research for further analysis it had to answer two criteria, firstly
that it is dealing with CP and secondly that it was performed in the above mentioned time frame.
All the research which answered the criteria was then analyzed and presented according to
following parameters: reference (first letter of the author and year, year the paper was published),
sample with age and number of participants, programme of physical exercise, programme
duration and research results.

Professional article SPORT AND HEALTH Vol X (2015) 2: 82-88
3. RESEARCH RESULTS
Procedure of collecting, analysis and elimination of obtained papers is presented in Table 2.
There were 264 papers identified according to key words. Number of research which was
eliminated immediately according to title, doubling and issuing date (before 2003) was 243 and
21 was subject to further analysis. In the further analysis of the remaining 21 papers 17 were
eliminated according to multiple criteria: abstract, because they were systematic research, non-
existence of control group in the research. Remaining four papers answered the criteria which are
publications from 2003 to 2011 and participants who are CP patients.
Тable 2. Procedure of collection, analysis and elimination of obntained papers
In Table 2 is presented the protocol for obtaining papers which answer the criteria.
Reference
Population
Group
Treatment
Protocol
Results
Andersson
et al. (2003)
People with SD.
Part of
population with
aids, part in
wheel chair.
EG (n=10 m/f,
age 23-44), CG
(n=7 m/f, age
25-47 ).
EG – programme of
progressive strength
training (speed of
walking, speed of
standing up, OMSUC),
CG-SDA
EG – twice a
week in 10
weeks, CG-SDA
Improvement in all the
variables, impact on
MS and ability to
walk.
Unger et al.
(2006)
School age
children who are
spastic CP
patients
EG (n=21 d/d1,
age13-21 .),CG
(n=10 d/d1,age
13-21 ).
EG – individually
designed programmes, 8-
12 exercises in 28 stations
(3D analysis of walking,
questionnaire) CG-SDA
EG – once or
twice a week, 8
weeks, 40-60
minutes. CG-
SDA
EG-significantly
different from KG.
speed, rhythm, length
of steps not
significantly changed.
Eek et al.
(2008)
Children with
bilateral spastic
CP.
n=55, age 5-15,
middle age 10,7
years.
Ratio of muscle strength
and walking (eight muscle
groups in legs by
myometer)
Measuring
standing,
walking, running,
jumping.
Differences in muscle
strength and MS.
Muscle weakness
influences the walk.
Electronic
database search
results: 264
papers
243 papers eliminated:
-According to title
-Being double papers
-Papers published before
2003
21 paper subject to further analysis
according to abstract and body text
17 papers eliminated according to
following criteria:
-abstract
-research overview
-inadequate topic
4 papers answered all
the criteria

Professional article SPORT AND HEALTH Vol X (2015) 2: 82-88
Тable 3. Overview of papers
DISCUSSION
Table 3 presents the overview of papers dealing with programmes of exercise for people
with cerebral palsy. In the table are results of application of specific exercise programme as well
as the methods used in work with the patients. Analysis of the data shows that various exercise
programmes have mostly positive results in rehabilitation of patients with CP.
In the first row is data about the research conducted on the sample of 17 participants, 10
participants in the experimental group were aged 23-44and 7 participants in the control group
were aged 25-47 and they had spastic dysplegia. A number of participants was using walking
aids whereas a part of group was using wheel chair for a prolonged period of time. Experimental
group was under influence of programmed progressive strength training and under treatment
twice a week for 10 weeks. They have improved walking speed, speed of getting up and overall
motor abilities. Improvement and increase of muscle strength results in significant improvement
in walking abilities for CP patients.
The second row presents research results of the research conducted on the sample of 31
school age children with spastic CP. Experimental group consisted of 21 participant and control
group consisted of 10 participants. They were all aged 13-21. Program lasted for 8 weeks, twice
a week lasting 40-60 minutes and it was designed individually for each participant who
performed eight to twelve exercises on 28 pages offered stations of circular exercise method.
Effects were measured by 3D overview of child’s walk before and after experiment and a
questionnaire. Effects compared to control group were positive, both in experimental results and
the questionnaire where perception was significantly increased. Speed, rhythm and length of
steps were not significantly changed.
The third row of the table presents research data for the sample of 55 participants aged 5-
15 with bilateral spastic CP.
Ratio of muscle strength and walk was measured according to eight groups of leg muscles tested
by manual myometer. Segments taken into consideration were: standing, walking, running,
jumping. It was determined that muscular weakness influences walking.
Final, fourth row of the table presents research data on 14 participants with CP, aged 6-16. Aim
was to research the possibilities of interactive game use as a motor activity for children with CP.
Treatment lasted for four weeks. Children’s motor abilities were significantly improved as well
as the motivation due to the use of such contemporary manner of rehabilitation. Interactive game
has proven to be a great choice. Specific motor effects have to be additionally subjected to
research.
Total number of participants in this systematic overview was 117. Fourth row in the table
had the smallest number of participants, 14, whereas the third had the largest, 55.
Rehabilitation programmes are mainly focused on establishing body functioning starting
with muscle tonus and their strength, controlled energy consumption and other relevant issues we
Sandlundab
et al. (2011)
Children with
CP.
n=14 , age 6-16
.
МА and movement
according to test mABC-
2, test of motor
knowledge BO, test of
one minute walking and
according to ETPS2.
Treatment at
home lasting 4
weeks
Motivation and PI
improved. Motor
movement improved.
Useful method for
rehabilitation.
SD-spastic dysplegia; ЕG-еxperimental group; CG-control group; n-number of pšarticipants; SDA-standard daily activity; ОMSUC-
evaluation of overall motor ability; CP-cerebral palsy; 3D-Three dimensional; BО- Bruininks-Oseretsky test; ETPS2-EyeToy for PlayStation
2;d/d1-boys and girls; m/f-male and female; МА-motor activities; МS-muscle strength; МS-motor ability; PI-practical interpretation
извођење.

Professional article SPORT AND HEALTH Vol X (2015) 2: 82-88
have mentioned in this research. Programme of progressive strength training which lasted for 10
weeks with training frequency twice a week had the best results in this research.
Paper presented in the third row dealt only with the ratio of strength and walking ability
estimate for children with CP, whereas the paper in the first row had the longest programme
duration-10 weeks.
CONCLUSION
CP is permanent disorder of posture and movement which reflects on many aspects of child’s
health status. Rehabilitation programmes are mainly focused on the body functioning starting
with muscle tonus, controlled energy consumption, strength and other relevant issues mentioned
in the research. Regular, professionally guided and persistent programme activities with the
patients with CP give good results.
It is evident that treatments for strength development of the extremities are not sufficiently used
and therefore we need to draw more attention to introduction of new and innovative concepts in
that area. Only with the cooperation with the parents, CP patients and experts in creation of
programmes for rehabilitation of CP patients shall we come to more positive and useful results
which certainly present positive direction for the rest of their lives.
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