Physical Therapy for Adults with Cerebral Palsy
by Rikke Damkjær Moen - Physiotherapist and Medical Manager on April 21
For individuals with cerebral palsy, it is recommended to start physical therapy as soon as possible. But what does it entail for an adult individual, and how should it be executed?
What does it entail?
Physical therapy is a branch of rehabilitative health, considered to be one of the most important aspects when treating individuals with disabilities, such as cerebral palsy. Physical therapy can help individuals relieve muscle pain and stiffness, improve mobility, and prevent movement problems from getting worse. Overall, the main goal is to improve the ability to participate in and perform daily activities through the use of exercises, treatments, and assistive devices – all tailored to the needs of each individual (source).
The purpose of using assistive devices is to support individuals in daily activities, and to assure further participation and independence in different arenas, such as at school, at work, and at home. Examples of assistive technologies are wheelchairs, standers and walkers. It’s important that each individual’s needs are thoroughly assessed by a professional to better determine the right type of assistive technology (source).
That being said, there has been little research and attention devoted to adults with cerebral palsy, and the knowledge within this population is limited (Peterson, Gordon and Hurvitz, 2012). As a result, adults with cerebral palsy are poorly understood, which makes it challenging to prevent health complications and facilitate right treatment (Peterson, Ryan, Hurvitz & Mahmoudi, 2015). This has implications in daily life as well, where public spaces and gyms often are poorly facilitated, creating a barrier to participation. The focus here will be on recommended activities, but it’s important to keep in mind that there is still a lot of work to be done in terms of removing participation barriers (Jahnsen 2005).
Physical therapy in adulthood
Though it’s recommended that individuals with cerebral palsy start treatment from an early age, physical therapy is just as important for adults as it is for children. In fact, an individual may be increasingly affected by the disability through life, due to the extra stress and strain put on the body over time (source). As the body grows, there’s also a need to maintain relative body strength in order to keep mobility levels up.
Research also suggests that adults with cerebral palsy have high odds of developing chronic conditions, such as diabetes, asthma, and heart diseases. These diseases have shown to be associated with high mobility impairment, due to fatigue, walking inefficiency, and muscle and joint pain (Peterson, Ryan, Hurvitz & Mahmoudi, 2015). This emphasizes the need that adults have for physical therapy and reducing sedentary behavior – not only to better overcome day-to-day challenges, but also to avoid chronic conditions from developing.
Though some individuals might not be able to perform certain activities and exercises, it’s important to remember that just a little bit of activity can help to achieve health benefits. With that in mind, exercising should not be considered all-or-nothing. In fact, a lot of adults start small and gradually progress over time, so it’s fully possible to reach new fitness levels by doing less than recommended (source).
Physical activities and exercises
Studies suggest a combination of cardiorespiratory endurance training and muscle strengthening, and a reduction in sedentary behavior to improve health, fitness and overall mobility.
To improve cardiorespiratory fitness, it’s recommended to focus on exercises that involve major muscle groups, and are continuous and rhythmic in nature. Examples are step-ups, cycling, arm ergometry exercises, and swimming. These exercises should be completed at least 2-3 times a week, with a minimum of 20 minutes per session. Again, this might not be achievable for everyone, and adaptations should be made to fit each individual’s needs.
In addition, muscle strengthening exercises should be included to reduce muscle weaknesses and increase strength. Exercises include multi-joint exercises, such as lateral step-ups and squatting, and single-joint exercises, such as knee extension. To avoid overtraining, it’s recommended to start with a familiarization period, and from there, increasing the training dosage over time according to each individual’s level (source).
Still, it’s important to remember the benefits of reducing sedentary time. Studies show that transitioning from a seated to a standing position can help to reduce sedentary behavior, suggesting that achieving higher fitness levels is not only a question of exercising but also a lifestyle and behavior matter (source). Physical therapists might therefore encourage to maintain a healthy and active lifestyle outside therapy sessions.
Last, but not least, exercises and activities should be functional in nature and help each individual to better overcome their daily challenges. Some may benefit from increasing their strength in order to better move from wheelchair to bed, while others might benefit from training with a walker in order to improve their mobility at home.
If exercises are easily transferrable to day-to-day life, individuals might better see the benefits of their work, and become more motivated to pursue a healthy lifestyle.
Peterson, Mark D. et al. "Chronic Conditions In Adults With Cerebral Palsy". JAMA 314.21 (2015): 2303. Web.
Peterson, M., Gordon, P. and Hurvitz, E. (2012). Chronic disease risk among adults with cerebral palsy: the role of premature sarcopoenia, obesity and sedentary behaviour. Obesity Reviews, 14(2), pp.171-182.
Jahnsen, R. (2015). Cerebral parese i livsløpsperspektiv. SOR Rapport, 5, pp. 6-18.