A pragmatic community exercise programme for young people with cerebral palsy: A pilot study

Abstract

Introduction andaim: Peoplewith cerebral palsy (CP) are often discharged from paediatric services at the age of 16–21 years. However, as they reach adolescence and body weight and height increases, the energy required to ambulate also increases [1]. In addition, people with CP often show reduced levels of muscle strength [2]. These factors may explain why 75% of people with CP who lose the ability to walk do so at around 25 years. Therefore the aim of this pilot study was to investigate the feasibility of a community based exercise programme and its effects on improving physical fitness and function in adolescents and young adults with CP. Patients/materials and methods: Eight participants with diplegic and hemiplegic CP (GMFCS I-III) (mean age 20 years) took part in an exercise programme which included a mix of strength and aerobic exercises at their local leisure centre under the supervision of a fitness instructor. Instruction was delivered by a physiotherapist on 2–3 occasions. The programme prescribed three sessions per week for weeks 1– followed by two prescribed sessions during weeks 7-12. The participants underwent gait analysis at baseline (BL) and after approximately six (T2) and 12 weeks (T3) of the exercise programme. The assessment also includedmeasures of knee extensor, hip extensor and hip abductor strength (using an MIE Myometer), Gross Motor Function Measure (GMFM) dimensions D and E, a CP-specific 10m shuttle run/walk (SRT), the Rosenberg scale for Self Esteem and step count. Results: Two participants dropped out the exercise programme and did not return for the T3 assessment. The other six participants showed good compliance with the exercise programme (91% and 75% attendance of prescribed sessions for the 1st and 2nd block of sixweeks respectively)with no adverse events. Outcomemeasures at BL, T2 and T3 are shown in Table 1. Statistically significant effects of the exercise programme between BL and T3 for hip extensor strength and the Rosenberg Scale for Self-Esteem between BL and T3 for GMFM dimensions D&E were found. A trend (Cohen’s d=0.90) toward improvement was also found for hip abductor strength. Discussion and conclusions: This pilot study showed that for the majority of the participants with varying levels of function, exercising at a local leisure centre is feasible and safe. Preliminary results also indicate that this pragmatic community exercise programmecanbe efficacious in improvinghip extensor strength, gross motor function and increasing self-esteem.