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Cerebral Palsy

Cerebral palsy is a condition, not a disease, which affects volitional movement throughout the individual’s lifespan. There are several types of cerebral palsy and the movement patterns of individuals with each type vary immensely. Recommendations for aquatic programming for individuals with cerebral palsy will be made based on the type of cerebral palsy

 

 

Spasticity
The student with spastic cerebral palsy typically has hypertonicity with concomitant muscle and joint contractures which restrict the range of motion about the involved joints.

  • The water needs to be warm for the individual with spastic cerebral palsy. In order to promote ease of movement and enhance stretching, the water needs to be between 90-93 degrees.

  • The determination regarding which functional movement in the water is most appropriate for an individual with cerebral palsy is entirely dependent upon the severity of involvement and the limbs involved.

  • An individual with spastic cerebral palsy often has dominant flexor and adductor tonus so movements which emphasize extension and abduction are crucial, elementary breast-stroke pull, for example.

  • Gait training in the water is a particularly effective way of helping the individual work on walking skills in a relatively gravity-free environment. If possible, walking up and down stairs in the water is very useful in developing contralateral walking skills.

  • Range of motion activities in the water, to music, in and through aquacises or aquarobics, may be particularly helpful.

  • An individual with quadriplegic spastic cerebral palsy will require flotation support from a teacher or a support device which helps the individual keep his/her mouth 3-4" from the water when using the device. An individual with severe involvement should be given every opportunity to move freely within the water…e.g., without an adult holding the individual.

  • Water activity must begin with a gentle warm-up, build to aerobic exercise, and culminate with a warm-down. The emphasis, whether in an aquacise or a swimming class should be on slow, long, and fluid movements.

  • Activities which vigorously stimulate tendon reflexes should be avoided – jumping, hopping, or skipping in the water.

  • Care must be taken on the pool deck to accommodate the needs of a learner with an unstable gait. The surface must be dry and the learner needs a "spotter".

  • This may be a perfect opportunity to combine movement and conscious relaxation

 

Athetosis

The athetoid form of cerebral palsy is characterized by excessive, uncoordinated, overflow movements associated with the attempt to move. In fact, the movements tend to become exaggerated when the individual gets excited. The fluctuating muscle tone interferes with attempts to create propulsive force in the water…and on land, for that matter.

  • A warm water environment is crucial.

  • Support is necessary to keep the head above the water.

  • Particular care must be taken to ensure the student’s mouth, which usually is open, is well above the water during activity.

  • Soothing, relaxing music may be helpful to the individual.

  • This may be a perfect opportunity to combine movement and conscious relaxation.

  • Care must be taken on the pool deck to accommodate the needs of a learner with an unstable gait. The surface must be dry and the individual with cerebral palsy needs a "spotter".

 

Ataxia

The individual with the ataxic form of cerebral palsy has significant difficulty with balance and equilibrium, lack of coordination and poor muscle tone.

  • • Flotation devices should be used only in exceptional situations as the individual has difficulty with equilibrium on dry land. The water environment provides a new and unusual opportunity and challenge regarding maintenance of equilibrium.

 

Carol Huettig, Ph.D.
Visiting Professor
Texas Woman’s University

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