Exercise as it relates to Disease/Aquatic exercise interventions for children with cerebral palsy

This is an analysis of the research article ‘Effects of a movement and swimming program on vital capacity and water orientation skills of children with cerebral palsy’.

What is the background to this research?
The term cerebral palsy (CP) is applied to a group of motor disorders defined by clinical description; cerebral palsy is an umbrella term that covers a vast range of cerebral disorders that result in childhood motor impairment. Cerebral palsy affects the ability for a person to move, the condition does not deteriorate over time though it is caused by damage to any part of the brain during pregnancy or shortly after birth

CP is the most common physical disability in children in Australia with 1 in 500 children born with the condition each year.

The disability affects different people in different ways; CP affects body movement, muscle coordination, muscle control, posture, muscle tone and balance.

There have been significant studies showing the improvement of quality of life through resistance and strength training in adults living with CP, these studies showed improvements in muscular strength without the increase of spasticity.

There are many different exercise interventions that can improve quality of life for people suffering from cerebral palsy, for the purpose of this study it will focus on aquatic exercise for children.

Swimming is one of the most frequently reported physical activity (PA) in children and adolescents with CP, information on its effectiveness and safety is highly sought after. The purpose of the present study was to evaluate the effect of a 6-month movement and swimming program on the respiratory function and water orientation skills of children with cerebral palsy (CP).

Where is the research from?
The research for this study comes from authors:
 * Yeshayahu Hutzler PhD
 * Anat Chacham BED
 * Uri Bergman MSW
 * Amir Szeinberg MD

For The Israeli Sport Center for Disabled and the Zinmari College for Physical Education and Sport Sciences, Tel Hashomer, from the journal of Developmental Medicine & Child Neurology

What kind of research was this?
This research was a small qualitative controlled scale research. The study was based on children suffering from cerebral palsy in Israel.

What did the research involve?
This research involved 46 kindergarten children ages 5 – 7 (both males and females) who were individually assigned to either a treatment or control group.

The purpose for this was to examine the effects of a 6-month movement and swimming schedule on the respiratory function and aquatic orientation skills for children living with cerebral palsy.

The program required these two groups to participate in swimming sessions twice a week, and also participate in PA sessions once a week.

Sessions were designed to last 30 mins over a time period of 6 months.

Kids in the control group were tested four days a week for a time period of 30 minutes each time with Bobath (neurodevelopment) physical therapy

What were the basic results?
Results showed that children with cerebral palsy have reduced lung function, compared to children in the normative data of the same category.

Further results showed that children in the treatment group had an improvement in baseline vital capacity results by up to 65%.

Compared to children in the control group who only improved by 23% overall.

Finally the aquatic exercise interventions had a stronger effect compared to previous physical therapy studies.

How did the researchers interpret the results?
Hutzler et al interpretation of the results found the relation between the dependent variables for the whole study was moderate, with a substantial correspondence between vital capacity (VC) and the raw data scores.

What conclusions should be taken away from this research?
Although proven effective in the study, conclusions that should be taken away is the fact that cerebral palsy has different levels of severity, which can be classified by gross motor function, these classes being:


 * Communication Function Classification System


 * Gross motor Function Classification System


 * Manual Ability Classification System

Some of the participants suffering from CP might not be capable of swimming or participating in programs designed for more able bodied suffers, some sufferers could be bound to a wheelchair and require 24/7 personal care.

This study did not accommodate for the severe cases of cerebral palsy.

What are the implications of this research?
The implications of the research was that based on the results a combination of aquatic and physical activity (gymnasium based) is the most likely way to improve the respiratory function of children living with cerebral palsy as well as improve their skills in the water, i.e. swimming, floating, treading water, stroke pattern and breathing skills.

It has been recommended that aquatic exercise interventions should be included in therapeutic programs in children living with CP.