Aquatic Exercise for Children with Cerebral Palsy (CP)

Aquatic exercise is a creative and unique form of exercise for children with cerebral palsy to develop their endurance, muscular strength, motor skills functionality, and self-image.

Abstract written by Nekram Upadhyay Kelly, M. & Darrah, J., 2005

This article reviews the research and developing theories that encourage therapists to consider water-based exercise rather than land-based exercise for children with cerebral palsy.

Over the years, much research has been conducted on improving overall health of children with Cerebral Palsy. Most of this research has stressed developing land-based aerobic and progressive resistance exercise for non-ambulatory children with Cerebral Palsy. The results achieved from these studies have shown significant increases in muscle strength as well as walking speed, wheelchair endurance, physical appearance, and gross motor functions.

The effects of land-based exercise for children with Cerebral Palsy have often involved ambulatory children with little being reported about the effects on non-ambulatory children. In land-based environments, attaining sufficient intensity, safety, and control of aerobic and progressive resistance exercise for children with poor motor control, impaired balance, joint pathology, joint instability, and severe contractures often poses a challenge.

This review describes how the buoyancy of water reduces joint loading and impact, and decreases the negative influences of poor balance and postural control. These characteristics may allow children with Cerebral Palsy to exercise in water with more freedom than on land.

To monitor the aerobic intensity in aquatic environments, the researchers used telemetry heart-rate straps and ratings of perceived exertion, specifically the Children’s OMNI Scale of Perceived Exertion.

Subjects performed a variety of exercises in water, including:

  • Length swimming
  • Shallow-water tuck jumps
  • Stride jumps
  • Jumping jacks (star jumps)
  • On-the-spot and propulsive running
  • Wall-and-sit kicking (i.e., holding onto the ledge and kicking with the legs).

Participation in aquatic exercise was facilitated by support from the wall, a foam ‘pool noodle’, a floating kick board, a floating barbell, a life or neck jack, or another person (skilled in working in the water with individuals with physical disabilities).

Participants reported improvements in flexibility, respiratory function, muscle strength, gait, and gross motor functions. None of the studies evaluated showed negative effects of aquatic exercise on the level of fatigue in children with Cerebral Palsy. The results were of particular benefit for the children who had significant movement limitations and who may, therefore, have had more difficulty performing land-based exercise.

Aquatic exercise is a creative and unique form of exercise for children with cerebral palsy to develop their endurance, muscular strength, motor skills functionality, and self-image. Further evidence is needed in order to fully assess the merit and safety of these programs; therefore, they should be planned and executed carefully.

Factors that need to be considered when implementing aquatic exercise in children with CP are:

  1. Ensuring adequate intensity, duration and frequency to promote the fitness effect
  2. Determining when a group environment may be more beneficial than individual interventions
  3. Ensuring that the pool environment is suitable and safe for intervention.

Cerebral Palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement.

Cerebral refers to the cerebrum, which is the affected area of the brain (although the disorder most likely involves connections between the cortex and other parts of the brain such as the cerebellum), and palsy refers to disorder of movement. Furthermore, paralytic disorders are not Cerebral Palsy – the condition of quadriplegia, therefore, should not be confused with spastic quadriplegia, nor tardive dyskinesia with dyskinetic cerebral palsy, nor diplegia with spastic diplegia, and so on.

Cerebral palsy’s nature as an umbrella term means it is defined mostly via several different subtypes, especially the type featuring spasticity, and also mixtures of those subtypes.

Cerebral palsy is caused by damage to the motor control centers of the developing brain and can occur during pregnancy, during childbirth or after birth up to about age three. Resulting limits in movement and posture cause activity limitation and are often accompanied by disturbances of sensation, depth perception, and other sight-based perceptual problems, communication ability; impairments can also be found in cognition, and epilepsy is found in about one-third of cases. Cerebral Palsy, no matter what the type, is often accompanied by secondary musculoskeletal problems that arise as a result of the underlying disorder.

Improvements in neonatology (specialized medical treatment of newborn babies) have helped reduce the number of babies who develop Cerebral Palsy and increased the survival of babies with very low birth weights (babies which are more likely to have Cerebral Palsy).

Of the many types and subtypes of Cerebral Palsy, none has a known cure. Usually, medical intervention is limited to the treatment and prevention of complications arising from Cerebral Palsy’s effects.

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