Training Program For Cerebral Palsy Essay, Research Paper
Background and Purpose
This training program is for Bob, a male eleven year-old student with cerebral palsy. This requires him to use a wheelchair most of the time although he is able to stand and walk for short distances of approximately 30 feet when there is something to hang on to for stability. With more muscular training, that distance could be increased greatly as the only reason he cannot continue is fatigue and therefore the risk of falling or other injury. It should be noted that an assistant will be needed for this program. Bob also has limited extension at the knees and limited dorsiflexion at the ankle. He is underweight for his height as he is 4′11″ and only 77 lbs. but this could be due to the lack of muscular development in the legs and thighs.
Lord Roberts/Ellen Douglass School in the Winnipeg School Division has a program running where students with disabilities take a bus to the BoniVital Archibald Swimming Pool every Wednesday afternoon. This is a perfect location for the training sessions as it provides a fun environment to exercise in, he can walk with less than normal body weight and Bob is able to swim. The pool is 25 feet wide and 60 feet long with an increasing depth from 2′6″ to 4″; it is the smaller of the two pools at the complex. The only disadvantage to this is that the school only goes once a week and the children only get a half-hour per group of kids to be able to swim. This doesn’t leave a lot of time for a full training program, therefore exercises are also needed for home and more in-pool training is required during a public swimming time.
Through his training, Bob should gain in the areas of balance, flexibility, and muscular strength and endurance in the lower limbs. All of these contribute to one personal goal for Bob: independence. With a better ability to take on all of the days tasks, Bob would be able to live his life with a lot less aid from others. He could leave his chair if there were an obstacle that it disabled him from doing and manage to overcome it himself.
Bob is too young for the PAR-Q questionnaire however I was told that all of the children had to consult a doctor before participating in the swimming classes.
Explanation of Exercises for Assistant
Stretching – Hamstrings, Calf muscles
These stretches can be done at home but when Bob is at the pool, this portion can be done in the hot tub to help relax the muscles. Have Bob sit and try to extend his knee joint while you just help him by putting one hand on his thigh and applying a slight pulling pressure with the other hand that is holding the back of the calf. This will stretch his hamstrings. Also help him dorsi-flex (lift toes upward) his ankle as a stretch. Range of motion is normal at all other joints, those are the only two that need special attention.
Walk in pool – All-around lower body
Hold your arms straight out so that Bob may hold onto your wrist or hands for stability (he will slowly fall forward when not holding onto anything). Try not to bend your elbows as it doesn’t give Bob enough room to walk properly. Let him decide how fast to go; if you move to fast he is light enough that he will just start to float in the deep end and fall in the shallow end.
Reverse Leg Lifts – Gluteus maximus, Hamstrings
Have Bob lay on his stomach and raise his entire leg to the ceiling then slowly lower back down to the ground
Bent-Knee Leg Lifts – Iliopsoas
While sitting, have Bob flex his hip with his knee in a flexed position, then slowly return
Quadriceps Extension – Quadriceps
In a sitting position, Bob should extend his knee and slowly lower it again.
Hamstring Curls – Hamstrings
Standing and using the handles of the wheelchair for balance, bend one knee and return it to original position.
Squats – Quadriceps, Gluteus maximus
Bob does have enough strength to do squats in the pool but not on land. As of now he can only do them in the middle of the pool however as his strength gains he could slowly move towards to shallow end thereby putting more of his body above the water and increasing the weight.
Balance
Have Bob stand in the deep end and let go of your hands (stand without any aid). He cannot stand for very long by himself but he is slowly improving.
Toe Raises – Calf Muscles
Standing behind the wheelchair and using the handles to hold for balance and some support, go from a flat footed stance to being raised up on the toes and balls of the feet.
Toe Pulls – Dorsi-flexors
This can be done at home. Simply take an elastic strap and place it over the toes of Bob’s shoes wh
Wall-Walking – All-around lower body
This can also be done at home. Bob faces the wall and places his hands on it for support and by crossing foot over foot he should walk across the room.
Jumping – Quadriceps, Gluteus maximus, Calf muscles
When in the deep end of the pool, let Bob hold your hands for balance as he jumps and as he lands, starts another jump. Ten consecutive jumps form a set.
Training Schedule
Monday – Home
Place a warm towel or other source of warmth on the joints for 5 minutes
Stretch until you feel you are well stretched out (approximately 3-4 minutes)
Wall-walking – go until you think you may fall, take a one minute breather and
repeat twice more
Reverse Leg Lifts – 3 sets of 10 repetitions/leg (30 second rest in between sets)
Bent-Knee Leg Lifts – 3 sets of 10 reps./leg (30 second rest in between sets)
Tuesday – Home
Place a warm towel or other source of warmth on the joints for 5 minutes
Stretch until you feel you are well stretched out (approximately 3-4 minutes)
Quadriceps extensions – 3 sets of 10 reps./leg (30 second rest in between sets)
Hamstring Curls – 3 sets of 10 reps./leg (30 second rest in between sets)
Toe Raises – 3 sets of 10 reps. (30 second rest in between sets)
Toe pulls – 3 sets of 10 reps./foot (30 second rest in between sets)
Wednesday – Pool (time allotment of 30 minutes)
Stretch for 5 minutes in the hot tub
Walk in the deep end starting at one side, there and back 5 times
Squats – 3 sets of 10 reps. (30 seconds in between sets)
Balance – work on this for about 5 minutes
Thursday – Home
Place a warm towel or other source of warmth on the joints for 5 minutes
Stretch until you feel you are well stretched out (approximately 3-4 minutes)
Wall-walking – go until you think you may fall, take a one minute breather
and repeat twice more
Reverse Leg Lifts – 3 sets of 10 reps./leg (30 second rest in between sets)
Bent-Knee Leg Lifts – 3 sets of 10 reps./leg (30 second rest in between sets)
Friday – Home
Place a warm towel or other source of warmth on the joints for 5 minutes
Stretch until you feel you are well stretched out (approximately 3-4 minutes)
Quadriceps extensions – 3 sets of 10 reps./leg (30 second rest in between sets)
Hamstring Curls – 3 sets of 10 reps./leg (30 second rest in between sets)
Toe Raises – 3 sets of 10 reps. (30 second rest in between sets)
Toe pulls – 3 sets of 10 reps./leg (30 second rest in between sets)
Saturday – Pool (Public Swimming)
Stretch for 5 minutes in the hot tub
Walk in the deep end starting at one side, there and back 5 times
Squats – 3 sets of 10 reps. (30 seconds in between sets)
Jumping – 3 sets of 10 reps. (30 seconds in between sets)
Swimming – 2 sets of 5 laps (one front, one back) 2 minute rest in between
Balance – work on this for about 5 minutes
Sunday – Day Off
Program Change
For all of the exercises in the pool, they can be made more difficult by simply moving them to the shallow end to increase the challenge for Bob. In the case of the walking in the pool exercise switch it from walking side to side to walking from the deep end to the shallow so it becomes increasingly difficult the further he goes, then swim back to the other end and start over. Wall-walking could be replaced by leg lifts and raises; lay on side (right) and lift the leg on the ground (right) or raise the other (left). Bent-knee leg lifts and reverse leg lifts could be replaced by walking and using the wheelchair as a walker – to provide balance and support some weight. Quadriceps extensions and hamstring curls may be done with ankle weights or on a weight machine designed for these and toe raises and pulls could be replaced with step aerobics in the water as the pool has the equipment for this.
Conclusion
Through discussion with Bob I have found that he quite enjoys this program as he loves to be in the pool and can already see his own progress in balance. The days were chosen to provide a six day program with two days in the pool however Bob is usually busy with family on Sundays so that was made a designated day off.