1. Cerebral Palsy An Overview of Sports, Treatment, and Causes

2. Organizations and Facilities South Fraser Child Development Center – http://www.sfcdc.bc.ca Vancouver Adaptive Snow Sports (VASS) – http://www.vass.ca Sportability: CP Sports of BC – http://www.cpsports.com/ The Cerebral Palsy Association of BC – http://bccerebralpalsy.com/

3. Resources Cont. CP Sports of England and Whales - http://www.cpsports.org Canadian Cerebral Palsy Sports Association - http://www.ccpsa.com Glenrose Adolescent Services - http://www.adolescentservices.net/cpalsy.htm

4. Cerebral Palsy What Disabilities do you associate with Cerebral Palsy? What images come to mind when you hear the words Cerebral Palsy?

5. Causes Prenatal – Radiation exposure – Anoxia Perinatal – Premature Birth – Immature Ossification – Narrow Birth Canal Postnatal – Epilepsy – Brain Hemorrhage

6. CP Incidents More frequent in males than females 6 in every 1000 births (1960 US stat.) 2 in every 500 Canadian births Decreasing due to improved birth procedures

7. Classification Monoplegia – Affecting one limb – Typically an arm

8. Classification Cont. Hemiplegia – One side of the body affected – Arm usually more involved than the leg

9. Classification Cont. Triplegia – Three limbs involved – Usually both arms and one leg

10. Classification Cont. Quadriplegia – All four limbs are involved

11. Classification Cont. Spastic- approx. 50% of cases Athetosis Rigidity Ataxia Tremor Cerebral Palsy can also affect speech and hearing to varying degrees, from mild to severe

12. Sport Classification System 8 classes with 2 subcategories Category 1- competing from a sitting position Category 2- competing from a standing position Classified based on functional ability

13. Class One Athletes Usually unable to propel manual wheelchair Has difficulty in grasp and release motions Uses trunk motions to move head and arms Usually has difficulty altering sitting position

14. Class Two Athletes Capable of spreading fingers and thumb slowly Moves wheelchair by hand or foot May stand/walk but is unstable Difficulty with consistent isolated shoulder movements Limb movement to control the trunk

15. Class Three Athletes Has poor balance when sitting unsupported Supported standing or walking (ie: crutch) Limited shoulder ROM Ability to propel a wheelchair Will raise hips and straighten knees with vigorous arm movements

16. Class Four Athletes Has good sitting balance and body movement Arms and hands are generally unaffected Capable of powerful wheelchair push May walk with aids but uses wheelchair/throwing frame for sport

17. Class Five Athletes Has balance while standing Noticeable hip and shoulder rotation while walking May have inwardly bent knees and flat feet **Note: If athlete’s balance is poor with standing they may elect to compete as a class 4 athlete in a wheelchair

18. Class Six Athletes Ambulant athlete with all four limbs affected Has an overall lack of control when moving Able to walk unaided but with difficulty in balancing Rolling head movement during running Difficulty in hopping and skipping Unable to keep a clapping rhythm

19. Class Seven Athletes Ambulant athlete with arm and leg on one side affected Unable to hop on affected leg Often tilts head during exertion Normal throwing action but with an exaggerated motion Affected arm swings across body while running

20. Class Eight Athletes Minimal Disability Disability must be evident without going to medical proof More obvious disability during exertion Slight coordination problems Good balance

21. Sporting Opportunities Skiing (VASS) Soccer Athletics Boccia Swimming Sledge Hockey Dance Gymnastics Powerlifting

22. Adaptive Activity: Skiing Modified Walker Ski Bras Assistance Pole

23. Adaptive Activity: Soccer 7-A-Side soccer Smaller field and nets Wheelchair adaptation – A mount is placed onto the front of the chair so that the force of moving the chair is able to propel the ball forward

24. Adaptive Activity: Athletics Track events – Standing – Wheelchair Field Events – Javelin – Club Throw – Discus

25. Adaptive Activity: Boccia Great for persons with poor balance Easy to play from sitting position Requires little physical strength Participants are placed into 3 groups based on balance and strength

26. Adaptive Activities: Sledge Hockey Sleds with blades attached to bottom 2 sticks in each hand with picks on end Challenges – Upper body strength – Upper body balance

27. Adaptive Activity: Dance Rhythmic Activities – Use tambourines, ribbons, scarves, etc. to express movements Folk Dance – Reduce music speed – Move to every other beat – Reduce step number

28. Adaptive Activity: Gymnastics Rolling – Log roll down a wedge Balance – Balance on different body parts on the floor or mat Climbing Frame – In wheelchair underneath horizontal ladder

29. Adaptive Activity: Powerlifting Bench press only Available to CP3-8 athletes only Open event, all disability levels compete together 2 straps allowed to secure the legs at any point

30. Rehabilitation and Medical Treatments Swimming – Warm water can decrease the debilitating effects of Spastic muscle contractions – Cool water may help performance of Athetoid CP Botulinum Toxin Type A (Botox®) – Improved Gait Pattern – Reduction in Spasticity – Improvements seen after 2 weeks, 3 month duration – Suitable for children over the age of 2 yrs

31. Rehabilitation and Treatment Cont. Surgery – Orthopedic surgery on affected muscles – Neurosurgery: found to be less satisfactory Other Drugs-uncommonly used today – Valium – Dantrium Physical and Occupational Therapy – Use of orthopaedic splints-most useful treatment – Stretching

32. Rehabilitation and Treatment Cont. Hyperbaric Oxygen Therapy (HBO) – Improves motor control – Decreases muscle spasticity – Improves balance Speech Therapists

33. Scenario #1 You are a summer soccer recreation leader and have Derek, a child with Hemiplegic CP, participating in your group. He is capable of moving his right leg very well and can maneuver his wheelchair quite well with his good right arm. What modifications to the game would you make in order to help Derek participate fully in your camp?

34. Scenario #2 You are a PE teacher in an elementary school. Kristy is in the grade 7 class and has Spastic Paraplegic CP that affects her legs. She has little strength in her upper body but loves to be outside. The next unit you are teaching is Athletics. Which events would be best suited to Kristy and what concerns would you need to address in order for her to have fun and safely participate in the class?

35. Scenario #3 You are a volunteer at a Boys and Girls club. Many of the kids have showed interest in dance and you decide to start a Wednesday afternoon group. Kyle, a 10 yr old lower limb Paraplegic CP child, has shown great interest in your activity. What are some of the modifications to traditional dances could you do in order for Kyle to be as expressive as possible in your class?