Cerebral Palsy

An Overview of Sports, Treatment, and Causes

Organizations and Facilities

South Fraser Child Development Center – http://www.sfcdc.bc.ca

Vancouver Adaptive Snow Sports (VASS)– http://www.vass.ca

Sportability: CP Sports of BC– http://www.cpsports.com/

The Cerebral Palsy Association of BC– http://bccerebralpalsy.com/

Resources Cont.

CP Sports of England and Whales- http://www.cpsports.org

Canadian Cerebral Palsy Sports Association- http://www.ccpsa.com

Glenrose Adolescent Services- http://www.adolescentservices.net/cpalsy.htm

Cerebral Palsy

What Disabilities do you associate with Cerebral Palsy?

What images come to mind when you hear the words Cerebral Palsy?

Causes

Prenatal– Radiation exposure– Anoxia

Perinatal– Premature Birth– Immature Ossification– Narrow Birth Canal

Postnatal– Epilepsy– Brain Hemorrhage

CP Incidents

More frequent in males than females

6 in every 1000 births (1960 US stat.)

2 in every 500 Canadian births

Decreasing due to improved birth procedures

Classification

Monoplegia– Affecting one limb– Typically an arm

Classification Cont.

Hemiplegia– One side of the body

affected– Arm usually more involved

than the leg

Classification Cont.

Triplegia– Three limbs involved– Usually both arms and

one leg

Classification Cont.

Quadriplegia– All four limbs are involved

Classification Cont.

Spastic- approx. 50% of cases Athetosis Rigidity Ataxia Tremor

Cerebral Palsy can also affect speech and hearing to varying degrees, from mild to severe

Sport Classification System

8 classes with 2 subcategories Category 1- competing from a sitting position Category 2- competing from a standing position Classified based on functional ability

Class One Athletes

Usually unable to propel manual wheelchair Has difficulty in grasp and release motions Uses trunk motions to move head and arms Usually has difficulty altering sitting position

Class Two Athletes

Capable of spreading fingers and thumb slowly Moves wheelchair by hand or foot May stand/walk but is unstable Difficulty with consistent isolated shoulder

movements Limb movement to control the trunk

Class Three Athletes

Has poor balance when sitting unsupported Supported standing or walking (ie: crutch) Limited shoulder ROM Ability to propel a wheelchair Will raise hips and straighten knees with

vigorous arm movements

Class Four Athletes

Has good sitting balance and body movement Arms and hands are generally unaffected Capable of powerful wheelchair push May walk with aids but uses

wheelchair/throwing frame for sport

Class Five Athletes

Has balance while standing Noticeable hip and shoulder rotation while

walking May have inwardly bent knees and flat feet

**Note: If athlete’s balance is poor with standing they may elect to compete as a class 4 athlete in a wheelchair

Class Six Athletes

Ambulant athlete with all four limbs affected Has an overall lack of control when moving Able to walk unaided but with difficulty in

balancing Rolling head movement during running Difficulty in hopping and skipping Unable to keep a clapping rhythm

Class Seven Athletes

Ambulant athlete with arm and leg on one side affected

Unable to hop on affected leg Often tilts head during exertion Normal throwing action but with an

exaggerated motion Affected arm swings across body while running

Class Eight Athletes

Minimal Disability Disability must be evident without going to

medical proof More obvious disability during exertion Slight coordination problems Good balance

Sporting Opportunities

Skiing (VASS) Soccer Athletics Boccia Swimming Sledge Hockey Dance Gymnastics Powerlifting

Adaptive Activity: Skiing

Modified Walker

Ski Bras

Assistance Pole

Adaptive Activity: Soccer

7-A-Side soccer Smaller field and nets Wheelchair adaptation

– A mount is placed onto the front of the chair so that the force of moving the chair is able to propel the ball forward

Adaptive Activity: Athletics

Track events– Standing– Wheelchair

Field Events– Javelin– Club Throw– Discus

Adaptive Activity: Boccia

Great for persons with poor balance

Easy to play from sitting position

Requires little physical strength

Participants are placed into 3 groups based on balance and strength

Adaptive Activities: Sledge Hockey

Sleds with blades attached to bottom

2 sticks in each hand with picks on end

Challenges– Upper body strength– Upper body balance

Adaptive Activity: Dance

Rhythmic Activities– Use tambourines, ribbons,

scarves, etc. to express movements

Folk Dance– Reduce music speed– Move to every other beat– Reduce step number

Adaptive Activity: Gymnastics

Rolling– Log roll down a wedge

Balance– Balance on different body

parts on the floor or mat

Climbing Frame– In wheelchair underneath

horizontal ladder

Adaptive Activity: Powerlifting

Bench press only Available to CP3-8

athletes only Open event, all disability

levels compete together 2 straps allowed to

secure the legs at any point

Rehabilitation and Medical Treatments

Swimming– Warm water can decrease the debilitating effects of

Spastic muscle contractions– Cool water may help performance of Athetoid CP

Botulinum Toxin Type A (Botox®)– Improved Gait Pattern– Reduction in Spasticity– Improvements seen after 2 weeks, 3 month duration– Suitable for children over the age of 2 yrs

Rehabilitation and Treatment Cont.

Surgery– Orthopedic surgery on affected muscles– Neurosurgery: found to be less satisfactory

Other Drugs-uncommonly used today– Valium – Dantrium

Physical and Occupational Therapy– Use of orthopaedic splints-most useful treatment– Stretching

Rehabilitation and Treatment Cont.

Hyperbaric Oxygen Therapy (HBO)– Improves motor control– Decreases muscle spasticity– Improves balance

Speech Therapists

Scenario #1

You are a summer soccer recreation leader and have Derek, a child with Hemiplegic CP, participating in your group. He is capable of moving his right leg very well and can maneuver his wheelchair quite well with his good right arm. What modifications to the game would you make in order to help Derek participate fully in your camp?

Scenario #2

You are a PE teacher in an elementary school. Kristy is in the grade 7 class and has Spastic Paraplegic CP that affects her legs. She has little strength in her upper body but loves to be outside. The next unit you are teaching is Athletics. Which events would be best suited to Kristy and what concerns would you need to address in order for her to have fun and safely participate in the class?

Scenario #3

You are a volunteer at a Boys and Girls club. Many of the kids have showed interest in dance and you decide to start a Wednesday afternoon group. Kyle, a 10 yr old lower limb Paraplegic CP child, has shown great interest in your activity. What are some of the modifications to traditional dances could you do in order for Kyle to be as expressive as possible in your class?