Physical Education, Exercise Prescriptions, and Adapted Physical Activity
for People with Cerebral Palsy

Cerebral palsy is a term used to describe a group of chronic conditions affecting muscle coordination and body movement. This disorder is not caused by problems in the nervous or muscular systems, but instead, is caused by damage to one or more specific areas of the brain, usually occurring during fetal development; before, during, or shortly after birth; or during infancy. Faulty damage or development to motor areas in the brain disrupts the brain's ability to adequately control posture and movement (UCP, 2001).

Cerebral palsy symptoms may change over time, not necessarily getting worse, and differ from person to person. Symptoms may include difficulty walking or maintaining balance or difficulty with fine motor skills (e.g., using scissors, writing). While some people with cerebral palsy have been diagnosed with other medical disorders such as mental impairment and seizures, most individual cases do not always cause profound handicap. Signs of cerebral palsy can be detected in children as young as age 3 and young children with cerebral palsy are commonly slow to reach developmental milestones such as learning to walk, sit, roll over, crawl, or even smile (NINDS, 2006).

Even though cerebral palsy is not a "curable" disorder by accepted standards, therapy and training have been found to improve function (UCP, 2001). Through management, assistance and education, the majority of people with cerebral palsy can lead fulfilling and fully functional lives that people without cerebral palsy lead as well. People with cerebral palsy may be viewed by the uneducated person to be limited in achievements simply due to their physical appearance, when in fact that individual may be of high intelligence. It is our responsibility as future health care providers to keep this from happening. This is where physical education, exercise prescriptions, and adapted physical activity for people with cerebral palsy come into play.

Physical education for people with cerebral palsy can start by identifying objectives that pertain to that certain individual. More specifically, addressing the five major developmental objectives of physical education identified by the American Alliance for Health, Physical Education, Recreation and Dance: organic, neuromuscular, interpretive, social and emotional (Stopka & Todorovich, 2005). The organic objective for a person with cerebral palsy involves the proper functioning of their body systems as a basis for skill development. For example, extinction of inappropriate patterns of movement as seen in athetosis, which is involuntary/purposeless movements diagnosed to some people with cerebral palsy. By treatment of body function, a person with cerebral palsy can interact in his or her environment and carry out daily tasks. Under the neuromuscular objective, visual motor control harmoniously functioning with the muscular systems to produce desired movements is an example of how to overcome this hurdle (Stopka & Todorovich, 2005).

Moreover, under the interpretive objective, management of the person with cerebral palsy would have to depend on the varying degree of mental competence. The ability to understand, make valued judgments, and acquire knowledge concerning that individual's environment would have to be tailored to the person's intellectual capabilities that would have to be measured before any kind of physical regimen were to be attempted (Stopka & Todorovich, 2005). The social objective is a highly critical aspect playing into the physical education of a person with cerebral palsy due to the importance of interacting with individuals who do not have cerebral palsy. The education plays both ways, decreasing the ignorance of the public as well as increasing the acceptance of the person with cerebral palsy in society. Socialization of the person with cerebral palsy can therefore be viewed as a team effort including the person and public (Ayyangar, 2002).

The emotional well-being of the person with cerebral palsy is a physical education objective that in the past has not been focused on as having great importance. Participation in physical activity is important for the emotional health of the physically challenged child providing a heightened self-esteem and sense of achievement (Wind, Schwend, and Larson, 2004). Once all the objective for the person with cerebral palsy have been identified and are all understood, then the assignment of the specific activity can be done.

Exercise prescriptions for people with cerebral palsy should be specific to that particular individual's needs. For example, sports that can improve endurance, strength and cardiopulmonary fitness while providing companionship, a sense of accomplishment, and increasing self-esteem, are highly recommended, such as bowling, dancing and swimming (Wind, et al, 2004). Introduction of effective relaxation techniques, such as stretching exercises, can also be useful for spasticity, a type of motor expression experienced by many people with cerebral palsy. Overall, exercises that involve slow, repetitive, and large free range of movement is recommend for the individual with cerebral palsy (Stopka & Todorovich, 2005).

Figure 1: Assistive bowling ramp	Adapted physical activity for people with cerebral palsy is essential since the disorder is so much more a physical disability rather than a mental disability, for the most part. Positioning plays an important role in the adapted physical exercises. For example, adapting a game of bowling with an assistive ramp leading toward the standing pins is a great adaptation for a person with cerebral palsy. The exercise involves the handling of the ball, placing the ball on the top of the ramp, pushing the ball down the slope of the ramp, and feeling a sense of accomplishment once the ball knocks down the pins. If the person requires a wheelchair for locomotion, the wheelchair can be brought up close to the ramp to assist even further (See Figure 1).
Furthermore, flotation devices, inner tubes, rafts, floatable or sinkable toys, and hoops can all be used in adapting an aquatics exercise regime for a person with cerebral palsy (Stopka & Bowie, 2000). Among the benefits an aquatic environment can give a person with cerebral palsy are the warm water aiding in relaxation for the muscles thus improving muscle tone (Stopka & Todorovich, 2005)."Many people with sever disabilities have jumped, walked, hopped and leaped for their first time ever, in pursuit of their special toy as it floats by them. The 80% reduction in force of gravity allows for such an achievement too take place, but the special toy is often the catalyst for this small miracle" (Stopka & Bowie, 2000, p64). All in all, adapted physical activity/exercise therapy recommendations for people with cerebral palsy can have just that, results that appear like miracles (See Figure 2).
		Figure 2: Therapist assisting child with floatable toys.

With interest in such participation increasing, it is necessary for the physicians, therapists, and families of children with special needs to understand the preparticipation evaluation, athletic options, specialized equipment, and sport-specific risks (Wind, et al., 2004). In a research study focusing on the benefits of strength training for young people with cerebral palsy, participants reported psychological benefits such as a feeling of increased well-being and improved participation in school and leisure activities (McBurney, Taylor, Dodd, and Graham, 2003). Participation in everyday activities is considered to be a vital part of an individual's development, which is related to their quality of life and future life outcomes. Research studies indicate that children with disabilities are at risk for lower participation in ordinary activities (King, Law, King, Rosenbaum, Kertoy, and Young, 2003). It is the responsibility of the caregiver and of the educator to provide the resources necessary for the person with cerebral palsy to integrate and involve themselves in the required physical activity needed to improve their overall quality of life.

In conclusion, physical education, exercise prescriptions, and adapted physical activity for people with cerebral palsy are beneficial to not only the physical, but the emotional and social improvement of that individual. Research stresses that sufficient clinician resources must be allocated to solve individual equipment and exercise problems (McBurney, et al., 2003). In other words, future health care providers and educators must act as advocates, fight for the person with cerebral palsy or the person with any disability for that matter. I agree with Stopka & Bowie (2000) in using the word "miracle." No other word could be more appropriate for the significant positive change that one can have on another person's life.

References
Ayyangar, R. (2002). Health maintenance and management in childhood disability. Physical
Medicine and Rehabilitation Clinics of North America, 13(4), 793-821.

King, G., Law, M., King, S., Rosenbaum, P., Kertoy, M. K., and Young, N. L. (2003). A
conceptual model of the factors affecting the recreation and leisure participation of children with disabilities. Physical & Occupational Therapy in Pediatrics, 23(1), 63-90.

McBurney, H., Taylor, N. F., Dodd, K. J., and Graham, H. K. (2003). A qualitative analysis of
the benefits of strength training for young people with cerebral palsy. Developmental Medicine and Child Neurology, 45(10), 658-636.

NINDS: National Institute of Neurological Disorders and Stroke. (2006). NINDS cerebral palsy
information page. Retrieved on April 5, 2006, from http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm

Stopka, C., & Bowie, L. V. (2000). Adapted equipment ideas to facilitate inclusionary
teaching! (2nd ed.). Boston, MA: Pearson Custom Publishing.

Stopka, C., & Todorovich, J. R. (2005). Applied special physical education and exercise
therapy (4th ed.). Boston, MA: Pearson Custom Publishing.

UCP: United Cerebral Palsy. (2001). Vocabulary tips: Cerebral Palsy – facts & figures.
Retrieved on April 5, 2006, from http://www.ucp.org/ucp_generaldoc.cfm/1/9/37/37-37/447

Wind, W. M., Schwend, R. M., and Larson, J. (2004). Sports for the physically challenged
child. Journal of the American Academy of Orthopedic Surgeons, 12(2), 126-137.

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