Consult a trainer and doctor before starting any exercise program. ENTER AT OWN RISK.
This article has been copied and edited by Patrick Laugerude
Strength training, also known as resistive training, for people with cerebral palsy is a type of therapy that is often used in conjunction with other forms of exercise to increase muscle strength and flexibility. Strength training also prevents the atrophy of muscles that are rarely used—a common problem among persons with cerebral palsy.
How Strength Training Helps;
People who don't have cerebral palsy or other conditions that affect movement and posture are able to freely move and stretch their muscles and tendons as they walk, run or perform daily functions. This ensures that muscles, tendons, and bones all grow at the same rate. However, young people with cerebral palsy often have difficulty engaging in such activities, causing their muscles to grow slower than their bones. This results in contracture, one of the most serious complications of cerebral palsy. Strength training works to reduce the chances of developing contracture by keeping the muscles strong and limber.
Research has also found a correlation between leg muscle strength, posture, and walking ability, indicating that people with weaker leg muscles exhibit a tendency to crouch more in their gait. People with cerebral palsy may develop a “scissor gait” in which they walk on their toes with their knees bent inward. (not in all cases) Strength training is aimed at significantly improving gross motor skills such as standing, walking, and sitting. Also stronger legs help when training the upper body by bracing and supporting the body, proper form and the right amount of weight can be used to build the muscles being trained.
More Benefits of Strength Training
Studies have shown that strength training for people with cerebral palsy may lead to increased walking speed, walking efficiency, motor activity, and a reduction in spasticity.
Additionally, through repeated, controlled motion, muscles become trained to perform in specific ways that mimic normal body movement. So with strength training, a child or adult with cerebral palsy may learn to walk, stand, and move in the proper way allowing him/her to reach their maximum potential.
Cerebral palsy impairs motor performance, therefore reducing muscle strength and motor control. Movement and function are limited by increased muscle stiffness and soft tissue contracture. Over time, the deficits can negatively affect bone and muscle growth, range of motion, and the acquisition of motor skills.
Strength-training programs have gained increasing popularity as therapy for cerebral palsy. Therapy focuses on motor control and flexibility to limit or reduce muscle stiffness and soft tissue contracture. Training programs are aimed at improving strength, endurance, and overall physical fitness.
All human movement, from the blinking of an eye to the running of a marathon, depends on the proper functioning of skeletal muscle and its strength.
Why do we need strength?
Does a person with CP need strength training?
These are some of the questions that we ask ourselves as parents and therapists. The answer to the first question is simple. Without strength we are unable to live. Each movement of our body depends on muscle strength. Without strength we are unable to eat, talk, walk, move and breathe. Strength of the muscle is essential to perform daily activities and learn new functions. We can survive without endurance, speed, and flexibility, but we cannot without strength. Very often we forget about its importance.
Is strength training important for CP? Muscle strength is even more crucial for individuals with a disability than for those without. It has been confirmed by studies and clinical experience. Many times to help our children/ loved ones we try new methods of therapy involving sophisticated technology, medication and surgeries. We are able to use surgical procedures improve alignment of the bones, but very often not enough to learn a new function (walk, roll, sit). To learn those skills, we need to develop strength to control the muscles and the body.
Existing misconceptions about strength training; Very important facts about the development of strength in Children and adults, and explain the success of intensive therapy programs.
"Previously children with CP were not encouraged to strength train because it was felt this would increase spasticity and reduce flexibility, which would lead to the worsening of deformities and walking problems".
(1) Misconceptions Of Strengthening Programs:
Weakness is not a significant functional problem for them. An increase in strength will not improve function.
Most of them cannot control their muscles sufficiently to train them.
* Increased strength will increase spasticity.*
Strengthening programs result only in hypertrophy of the muscles, and it does not effect the nervous system.
Another misconception involves the confusion about the difference between weight (strength) training and weight lifting.
(2) Facts:
Dispelling these beliefs, many recent studies have demonstrated that:
1.
Even mildly affected persons with CP have significantly reduced muscle strength, with the degree of weakness even greater in those with greater neurological involvement. In fact, weakness appears to have a stronger relationship with the level of motor functioning than other common symptoms such as spasticity or muscle tightness.
2.
Individuals with CP can increase strength and improve passive motion through weight training.
3.
Individuals with CP can increase strength in most if not all muscles at the same rate as persons without a brain lesion. Most importantly, strength training programs can produce positive changes in walking ability and in the performance of other motor tasks. There is evidence of a relationship between lower limb strength values and motor abilities. An increase in strength of one muscle group does not change the outcome of function, but improvement in strength of more muscle groups will result in significant improvement of functional skills.
4.
No evidence exists to support the claim that strengthening exercises will increase spasticity. Strength training is perhaps most effective when performed in conjunction with other types of activities, exercises, or therapeutic interventions. In 1956, Massey and Chaudet demonstrated that heavy resistance training does not cause a decrease in flexibility. Spasticity has not been found to increase with strength training in the research done by Damiano, Mac Phail and
5.
Weight (strength) training for children is based basically on resistive exercises using their own body weight instead of lifting heavy weights. Our children are constantly doing resistive (strengthening) exercises using the weight provided from the child's own body. When a youngster does a push up, he lifts 60% of his body weight. If the child weights 50 pounds, he will lift 30 pounds performing push ups. Weightlifting, on the other hand, is a competition where participants lift as much weight as they can at one time.
(3) Strength Development:
For many years , strength gains were assumed to result directly from increases in muscle size (hypertrophy). Current research (Meredit, Frontera) proved that prepubescent strength gains are accomplished largely without any changes in muscle size.
Young individuals develop strength through:
- Improved motor skills coordination.
- Increased motor unit activation.
- And other neurological adaptations.
"During the first several weeks of resistive training, gains in strength are almost exclusively neural in nature, meaning the body is learning to recruit the correct muscles in the proper sequence while inhibiting unnecessary muscle recruitments. The physiologic changes, such as an increase in contractile proteins, stored nutrients, and anaerobic enzymes, take several weeks to develop. Once the neurologist "learning" phase begins to diminish, remodeling of the muscle is beginning to take place and strength gains continue". (LeMura)
During the first 2-4 weeks strength gains can be achieved without structural changes in the muscle, but not without neural adaptation. There are more neuro-functional adaptive changes than structural changes within the muscle. Thus, strength is not solely a property of the muscle rather it is the property of the motor system.
Also, during the first weeks of strengthening exercises there is a reduction in the co activation of other muscles (muscle synergies, pathological movements). It results in a decrease in energy expenditure, movement control improvement, and at the same time it leads to a decrease in spasticity (functional) resulting in functional improvement (or a great condition to achieve functional improvement).
After 4 weeks of resistive training, gains in strength are gradually achieved by increased size of the muscles (hypertrophy). The initial neural contribution to increase strength diminishes. At this time we will not notice further dramatic changes to the neuro-motor system of the body. Changes will be more specific and related only to the muscular-skeletal system.
(4) Intensive Exercise Methods:
Resistive training can induce adaptive alternations in nervous system function, along with changes in the morphology and architecture of the trained muscles. Resistance training will improve neural function and gains in muscle mass will benefit not only athletes, but also aged individuals and individuals with neuro-motor disorders. This will provide an effective way to improve everyday physical function.
During 2-4 weeks of intensive therapy sessions, young individuals with CP perform resistive exercises 3-4 hours per day, 5-6 days per week. Very often after this short period of treatment, these individuals present significant functional improvement. Based on the theory of strength development, the functional improvement occurring after a short period of strength training is related to motorneurological changes. In a short time individuals with CP improve movement control, balance and coordination. Often they are able to perform functional skills that they were not able to do before (sit, roll, walk).
This improvement is caused by adaptive changes that occur in the nervous system in response to strength training. Electromyogram studies have indicated other adaptation mechanisms that may contribute to an increased efferent neuronal outflow with training, including increases in maximal firing frequency, increased excitability, decreased presynaptic inhibition of spinal motor neurons, and downregulation of inhibitory pathways. Short term resistance training has been reported also to induce hypertrophy of slow and fast muscle fibers, induce alternations in muscle fiber architecture and fiber type distribution, and other morphological changes.
Resistance training creates many other positive adaptive morpho-functional changes in other systems of the body (skeletal, cardiopulmonary, endocrine, etc.).
(5) Summary:
To summarize, strength training in CP results in strength gains that are similar to those seen in persons without a central nervous system lesion, and produce positive outcomes in motor performance and functional skills.
For many individuals with cerebral palsy, strengthening exercises are important for their well-being. It allows them to maintain physically active lifestyles and overcome daily barriers. For many others, the improvement in functional skills achieved secondary to strength training allows them to perform for the first time in life new activities never done before. Secondary to improvements in strength, some individuals become more independent in daily life.
The information and facts presented here are convincing enough for persons and therapists to make it imperative to incorporate strengthening exercise programs in the life of each individual with cerebral palsy.
Facts About CP & Strength:
* Generally individuals with CP are weak.
* Spasticity is not related to muscle strength.
* Strength in CP is directly related to function.
* Strengthening does not increase spasticity.
* The energy cost of walking in children with CP can be up to three times greater than children
without CP
* Children with CP complain of fatigue at a very low exercise intensity
* Excessive co activation within and between body segments could be responsible for the high energy cost of walking in children with CP.
This section is written by Patrick Laugerude
This work out is for people with Cerebral Palsy.
The reason I’m not talking about every exercise is because I’m only focusing on areas that a person with sever C.P. might need help on. These exercises are not in any order or what day they should be done on or weight- sets- reps. Just advice on helping a person with sever C.P. in their work out. And hitting the muscles being exercised.
Find the best trainer you can, ask everyone, call gyms and really be sure to find a good trainer, don’t just go with some kid working at local neon club. Make sure they pay attention to you at all times, not looking around day dreaming while they’re suppose to be training you. They have to be willing to work with you.
Go to a store that sells exercise goods, for this one it can be TARGET or WAL-MART. Find a weight lifting belt large enough to go around you and any machine you will be using in all workouts, might be best to get two belts. Strap yourself into every bench or machine you use until you can exercise without them.
Basically your work outs will be the same as able bodied people, only with the use of weight machines until you are able to use free weights.
Chest work out- chest presses are best in a seated –chest press machine- most people with C.P. have to have someone hold their elbows up so that the forearms are parallel with the floor, throughout each repetition. To see watch another person do it and you can see that the elbows are up as they press to hit the chest muscles.
Incline press- I use a Smith machine- a 45 pound Olympic bar on glides, find a new model with counter weight. Have your trainer hold your elbows back so forearms are perpendicular to the floor and upper arms are parallel. Then fallow through the reps.
Flies- use a seated butterfly machine; push with elbows to squeeze chest muscles in each rep. hands should just rest on handles.
Shoulder presses- again use the Smith machine, this time sitting 90 degrees, strait, position the bench so the bar comes behind your head and have your trainer hold your elbows back so your upper arms are parallel with the floor as you press the weight up and lower the bar with a controlled movement. Same as incline.
Bicep curls- any plate loaded or stack machine will do, chances are once you get seated/ strapped in and have a hold of the handles, and you’ll be ready to go. Sets, reps, negatives, ask your trainer, these very from time to time.
Triceps- use a bench under a cable pull with stack weights, face away form the machine, and have the preferred attachment handed to you with the correct weight. Keep elbows to your side during exercise throughout reps. Press down, squeezing the triceps when striating the elbows.
Back exercises- just remember to keep your chest up and squeeze your back muscles hard at the end of each repetition, these are self explanatory when it’s time, your trainer should guide you through BACK DAY.
Abs- find a machine that bends in your mid section not your hips, belt goes across lap, hook feet under foot pads. Then crunch.
Patrick’s training for Bodybuilding
Monday- Legs
Leg lifts/ Quad machine-3 to 4 sets 15 to 25 reps
Leg curls-3 to 4 sets 15 to 25 reps
Leg press- 3 to 4 sets 15 to 25 reps
Tuesday- Chest and Biceps
Chest press-3 sets of 8 to 15
Flies-3 sets of 8 to 15
Incline press- 3 sets of 8 to 15
Bicep curls- 3 sets reps very
Thursday- shoulders/ triceps
Shoulder press- 3 sets of 15
Rear deltoid- 3 sets of 15
Shrugs- 3 sets 15
Lateral raises- very
Tricep press 3 sets of 15
One arm tricep press 3 sets of 15
Friday- Back
Row- 3 sets 8 to 15/ both wide and narrow grip, 6 sets in all
Lat pull 3 sets front and back, front narrow grip
Upper lat press down- 3 sets of 15
Lower back- 3 sets of 15
Wednesday/ Saturdays, Forearms
Abs- everyday or often
Cardio- everday
I use a spin bike, non electrical, the momentum gives me a smooth ride no matter the resistance or speed,