News - April 2011
Sport Specific Training for an Adolescent with CP
by Carolyn Graham, MS, PT
I was reading an interesting case report the other day in the Pediatric Physical Therapy Journal www.pedpt.com, Sport Specific Fitness Testing and Intervention for an Adolescent With Cerebral Palsy: A Case Report. This case report describes how a physical therapist developed and implemented a fitness-related intervention program that incorporated sport-specific goals of a 16 year old male with spastic diplegia.
The adolescent, who was born at 35 weeks, has a history of: hospitalizations related to an infection and being placed on a ventilator for several weeks, bilateral heel cord lengthenings (that were repeated) and bilateral hamstring lengthenings. Prior to the hamstring lengthening, it was reported that the participant had difficulty ambulating without support from walls and furniture. Approximately 9 months after bilateral hamstring lengthening and physical therapy, the participant was able to ambulate on even and uneven surfaces, ascend/descend stairs, jump forward (somewhat asymmetrically), hop multiple times on his dominant foot, and one time on his non dominant foot. The participant was reportedly unable to hop or jump previously. A little over a year after his surgery, the participant joined his high school wrestling team. A few months after joining the team, the participant expressed interest in improving his wrestling performance, specifically being able to get up and down from the mat more quickly, perform movements more quickly and increase his strength.
A physical therapy examination was performed using tests and measures specific to the fitness demands of wrestling. These tests were specific to anaerobic fitness (muscle power sprint test), agility (10×5-m sprint test), muscle strength, aerobic power (10-m shuttle run test), and activity measures of gross motor function (Gross Motor Function Measure, GMFM-66).
A fitness related physical therapy program was set up at 2x week, x 10 weeks. The therapy centered on interval training as to mimic the anaerobic energy requirements used in wrestling. This intervention was also chosen based off of studies that have shown that children with CP respond to interval training with improvements in strength, agility, and gross motor function. The participant started with a 5-10 minute warm up, followed by 1-2 cycles of an 8-station interval training program (jumping, therapy ball toss, lateral shuffle, transitions to and from the floor, high knee jog with exaggerated arm swing, modified, oblique sit-ups, squats, and push-ups). The participant worked up to a 2 minute duration of each activity, as wrestling competition consists of three, 2 minute periods per match. The interval training was followed by a 5 minute cool down and flexibility exercises (to address the flexibility needed to wrestle competitively). The participant also participated in a HEP on the days he was not at therapy. The participant did not have any muscle or joint pain during the course of the therapy nor did the program appear to negatively affect his quality of movement.
At the completion of his 10 week interval training session, the participant scored higher on all tests and measures. Additionally, the participant reported functional gains including getting up from the floor more quickly, riding his bike faster and for longer distances, running faster and jumping higher and faster. Functional gains were also made in wrestling, including getting up from the mat more quickly, and being more difficult to bring down in matches. He improved in his ability to perform jumping jacks and push-ups, and he was beginning to be able to jump rope. Informal observations included that the participant was experimenting more with his movement in therapy such as running and jumping on to crash mats and running and leaping over mats (previously not attempted). The participant also appeared more motivated to participate in therapy and more confident with his motor skills. He required decrease extrinsic motivators in therapy and appeared excited about the connection between his therapeutic activities and his personal goals of improving his wrestling performance.
I was really excited about this article. It seemed to support the use of fitness-related therapy intervention for addressing sport specific goals of a teen with CP. Even though this is a case study and lacks the control of a research study, I was happy to see that the participant made functional gains as well as improvements in testing. Here at the Boston Ability Center, we want to inspire confidence for all of our kids to try new recreational activities as well as improve in their current sport activities. We have several patients that are working towards the goal of running in a road race. They are all working hard on their individualized programs which include: treadmill training, interval training, strengthening, and flexibility exercises. We are so proud of all of our patients’ progress and can’t wait to cheer on our racers in the upcoming months!