【原创】脑瘫治疗 其他方法大观系列之 十二：Sport Programs介绍

Summary: As we all know exercise and sport is an easy and enjoyable way to get exercise. The benefits of sport are well known for able bodied individuals, and it is thought that those same benefits can be achieved through sport in individuals with cerebral palsy. Physical benefits of sports programs are increased muscle strength, flexibility, coordination of movements, increased cardiovascular and respiratory endurance, and prevention of progression of the individual’s secondary impairments. On top of the physical benefits, sport programs also offer psychological benefits. Children involved in sport learn team work and build self-esteem, which enables them in other aspects of their lives by building their confidence and teaching them social skills. Physical therapy through sport, used as a complement of traditional therapy provides a fun, safe and beneficial activity that children with CP can be involved in.

Aquatherapy
  Exercises the entire body without putting excess stresses on joints. (Getz, Kelly)
  A warm aquatic environment promotes relaxation and reduces tone allowing for more efficient movement. (Getz)
  The buoyancy of water decreases negative influence of poor balance and postural control
  If the child enjoys water swimming, kicking or just splashing around, a warm pool provides a fun way for the child to get exercise. (4mychild)

[]bCycling
  A stationary bike with postural modifications provides a safe and effective method of exercise. (Williams)
  Study showed that a relatively short program can lead to valuable improvements in functional ability such as standing or walking endurance. (Williams)

Skiing
  Provides an enjoyable adaptive therapy to promote long term participation and enthusiasm for gross motor rehabilitation (sterba)
  Adaptive skiing has shown to be beneficial for improvement of gross motor function in a small sample of children with CP (sterba)

Yoga
  The slow moving exercise reduces stress and improves mobility, flexibility, and muscle tone. (4mychild)

Dance
  A fun and effective way to help the child relax and have fun while building muscle tone and cardiorespiratory endurance. (4mychild)
  Endurance activity may help to increase strength of the lower extremity, decrease energy expenditure for walking, and improve gross motor function (Schlough)

Sports with balls
  Kicking and throwing ball’s provides a good way to improve coordination. (4mychild)

Available Evidence:

  Children with CP should be treated with a proactive approach that emphasizes more intense activity and lifestyle modifications and mobility enhancing assistive devices. Research has found that children with CP who engage in increased physical activity have better physical and mental health. (Damiano)

  Research on 5 individuals (GMFM level I (n=2), GMFM level II (n=2), GMFM level III (n=1)) showed a 5.4% and 3.2% in GMFM-D and GMFM-Total, respectively, after a 10-week adaptive skiing class. All the children were ambulatory at the onset of the study, though the authors stated that adaptations could be made for non-ambulatory skiers. This study shows evidence, though limited, that ADS can assist children in their developing years (4-12) in improving gross motor function in children with CP. (Sterba)

  Aquatic therapy is very popular though the results of a review of 11 studies found that the benefits of aquatic therapy were unknown. (Getz)

  Aquatic therapy is popular with children due to the reduced load on joints, decreased influences of poor balance and postural control because of the floatation of water. This article states that there is little known about aquatic exercise because research has not differentiated between aquatic exercise and aquatic therapy, which do not provide the fitness aspect. There have been a few studies that have looked at aquatic exercise that have found positive results, yet more research is needed. (Kelly)

  Suggestions from the American College of Sports Medicine give goals for children’s aerobic exercise as 30-60 minutes most or all days of the week at 70-80% max heart rate. For strength training they recommend 8-12 repetitions to volitional fatigue twice a week. It has been suggested that, in water, as velocity doubles the drag force quadruples. Resistance can be increased by use of paddles. (Kelly)

  Study looked at 11 children between ages of 11-15 with GMFM scores of IV and V. They found benefits of static cycling during the intervention phase but not in the follow-up phase in the ability to stand and walking abilities. This could be a source of exercise in non-ambulatory children. (Williams)

References:
Getz M, Hutzler Y, Vermeer A. Effects of Aquatic Interventions in Children with Neuromotor Impairments: A Systematic Review of the Literature. Clinical Rehabilitation. 2006;20:927-936
Kelly M, Garah J. Aquatic Exercise for Children with Cerebral Palsy. Developmental Medicine and Child Neurology. 2005;47:838-842
4MYCHILD. Available at: http://www.cerebralpalsy.org/treatments/exercise/. Accessed 1.30.2008
Williams, H. Effects of a static bicycling programme on the functional ability of young people with cerebral palsy who are non-ambulant. Developmental medicine and child neurology 2007;49:522.
Sterba J. Addaptive Downhill Skiing in Children with Cerebral Palsy: Effect on Gross Motor Function. Pediatric Physical Therapy. 2006;18:289-296
Schlough, K. The effects of aerobic exercise on endurance, strength, function and self-perception in adolescents with spastic cerebral palsy: a report of three case studies. Pediatric physical therapy. 2005;17:234
Damiano D. Activity, Activity, Activity: Rethinking our Physical Therapy Approach to Cerebral Palsy. Physical Therapy. 2006;86:1534-1540