Helping someone with cerebral palsy

[sheila]

I'm a personal trainer practicing in Glamorgan, Wales. Recently a young man with cerebral palsy contacted me to help him get fitter. He's a great guy who isn't 'disabled' by his condition at all. In fact he makes most people look like couch potatoes - he runs, he's a trained pilot, he goes pot holing and on as many adventure holidays as possible.

However, dispit all this I'm a little unsure about helping him. To be honest I'm nervous that a. I won't be able to help him and b. I might prescribe the wrong type of exercise and he will end up hurting himself. Can anyone help?

s

[Julian Meldrum]

Sheila, if you ever get the opportunity to take up the YMCA FIT level 3 training course on working with people with disability, go for it. Having taken that course, I can tell you that cerebral palsy is one of the conditions covered, and a few suggestions follow:

Firstly, as you've discovered for yourself, any disability - and CP especially - affects people very differently and you MUST work individually, communicate honestly and openly with the person and accept that there are two experts here: yourself and your client! This is the great challenge and joy of working with disabled people. Everyone is individual and different, but some people are more different than others, and sometimes you may yourself have to go back and look again at your basic assumptions. You may even find that this helps you think differently about some of your other clients.

CP is the result of a lesion in the brain that occurs around the time of birth and typically affects one side of the body more than the other (i.e. the side opposite to the lesion). It can affect speech or vision, but this does NOT mean that someone is necessarily intellectually impaired in any way. So do ask how his CP affects HIM, and how he deals with it. He's obviously a very bright person with well-developed problem solving abilities, and it's likely he already has some good ideas on how to deal with any limitations he has from CP. He may also be able to direct you to some good specific information resources which would help you both.

For example, he may need to stretch more than other people do, both before and after exercise, and you may be able to help ensure that he does this safely, easing gently into position, without compromising joints. Perhaps he has already had advice from physiotherapists on this. Perhaps you could talk to them too. He may already have found out some good ways to compensate for specific problems, e.g. through careful choice of gloves and strapping or wrapping hands or feet.

He may have some problems with posture - so check it out with him, but don't give up if he can't achieve 'perfect posture' in every exercise. The fact that he is into climbing suggests that he may well have above-average body awareness and core stability and be well up for further work in that area, so share your ideas and see how he goes with them.

He's already physically active, which is great: the biggest problem with most forms of disability is when people are inactive and de-conditioned. It is possible that strenuous exercise might cause some additional problems for him by way of muscle spasms, and he may already have discovered this for himself - so ask about it. The answer is to progress carefully, and individually, to learn as you go, but support him in challenging himself, which is clearly what he wants to do. Here's hoping you both have some great times and a productive working relationship!

[sheila]

Thanks Juilan, some great advice that I'll incorporate into my clients programme. I'll also take a look at the YMCA course - It did Future Fit which didn't include training for such special populations.

Finally, a point of note ... I have read that exercisers can 'think' themselves stronger by performing an exercise on one part of the body (say a single leg extension) and 'thinking' about replacating the same exercise on the other leg without actually performing it. I mention this because this may help my client as he has problems with one arm and one leg in particular.

s

[Julian Meldrum]

Sheila, it sounds like you're already doing the research and thinking about the issues, which is really good, and you're listening to your client, which is the most important thing. Nothing wrong with a Future Fit qualification, and it doesn't stop you getting REPs points as well as useful training from other providers.

Left-right asymmetry means you may have to work differently on the affected arm/leg to the other one, but doing some work on both is still important. The research you mention may be relevant, but don't rely on it totally.

Getting technical, there's a 'wiring problem' in CP which means that in affected limbs the antagonist muscle does not automatically relax when the agonist (prime mover) is engaged in an action. Therefore the person needs to work towards getting more conscious control over that process. When the antagonist finally relaxes there may be sudden, jerky movement which goes further than the person intended. So work on range of movement exercises, assess how this varies in different conditions, compare one side to the other, and so on. As I said, you have the ultimate expert on tap - your client!

There is no value in limiting what someone does on their good side just for the sake of symmetry: the focus should be on what the person can do, and is seeking to do, and doing it as well and safely as possible, accepting that they will do some things differently from another individual who does not have that impairment.

Hope things go really well, and you may even find that one client leads on to another ...