Cerebral Palsy: Understanding, Managing, and Improving Mobility

Cerebral palsy (CP) is the most common physical disability in children, affecting movement, posture, and muscle coordination. While we can’t change the brain injury that causes CP, we can improve strength, balance, and functional independence through targeted exercise. Accredited Exercise Physiologists can guide children and adults with CP through safe, effective programs that enhance mobility, reduce complications, and improve quality of life.

CP refers to a physical disability that impacts posture and movement, and among children it is the most prevalent disability. The term CP describes a collection of disorders that impair an individual’s ability to move. Most commonly, it is caused by damage to the developing brain during pregnancy, at birth, or shortly after birth. This condition is lifelong, although non-progressive in nature.

These movement impairments can affect:

• Functional tasks such as reaching, sitting, stepping, and walking
• Coordination and balance
• Muscle tone and reflexes

Types of Cerebral Palsy

Spastic Cerebral Palsy (80% of cases)

• Increased muscle tone causing stiff movements

Subtypes:

• Diplegia/diparesis: mainly impacts the legs and can cause a scissoring gait
• Hemiplegia/hemiparesis: impacts one side of the body, typically the arm more than the leg
• Quadriplegia/quadriparesis: impacts all limbs, often accompanied by sensory or intellectual difficulties

Dyskinetic Cerebral Palsy

• Involuntary jerky or writhing movements
• Fluctuation of muscle tone throughout the day
• Can impact swallowing, tongue, and facial muscles

Ataxic Cerebral Palsy

• Impaired coordination and balance
• Unsteady movements, causing difficulties with fine motor skills and walking

Mixed Cerebral Palsy

• Combination of two or more types, most commonly spastic-dyskinetic

Common Symptoms

• Muscle tone abnormalities: fluctuating tone, hypotonia, or spasticity
• Movement and coordination difficulties: impaired fine and gross motor skills, jerky movements
• Postural and gait impairments: delayed milestones, poor balance, persistent reflexes, wide-based or scissoring gait
• Associated conditions: hearing or vision impairments, cognitive difficulties, swallowing issues, seizures
• Pain and secondary complications: fatigue, muscle contractures, joint deformities

Risk Factors

Although CP cannot be prevented, there are several associated risk factors:

Prenatal:

• Multiple births
• Maternal infections
• IVF
• Pre-eclampsia
• Thyroid disease

Perinatal:

• Stroke or birth trauma
• Low birth weight
• Neonatal encephalopathy
• NICU admission
• Prematurity

Higher Risk Groups:

• Multiple births
• Low birth weight infants
• Premature infants
• Males

How Exercise Helps

Exercise is essential for children and adults with CP. Research shows that structured programs can improve cardiorespiratory fitness, muscle strength, balance, and overall functional ability. In addition, regular exercise supports improvements in postural control, coordination, and movement efficiency, which are critical for performing everyday tasks such as walking, transferring, and reaching.

It also plays an important role in reducing sedentary behaviour, which is typically high in individuals with CP, and helps lower the risk of secondary health conditions such as cardiovascular disease, reduced bone density, and deconditioning.

From a functional perspective, exercise can enhance independence and participation in daily activities, while also improving confidence and overall quality of life. When programs are individualised, progressive, and consistent, they promote positive neuromuscular adaptations without exacerbating spasticity, making exercise a safe and highly effective long-term management strategy for individuals with CP.

Key Exercise Findings

Cardiovascular & Strength Training

Verschuren et al., 2016 found:

• Aerobic exercise (wheelchair propulsion, arm cranking, swimming, treadmill) improved endurance across all GMFCS levels by 9–41%
• Resistance training (sit-to-stand, squats, step-ups) enhances lower limb strength and function without increasing spasticity
• Consistent activity reduces sedentary time (76–99%) and improves overall health and wellbeing

Balance & Postural Control Training

Xiao et al., 2020; Dewar et al., 2021 found:

• Exercise programs incorporating balance training significantly improved anteroposterior and mediolateral stability
• Task-oriented exercises targeting trunk control and reactive balance enhanced postural control
• Balance-focused programs improved gross motor function

The Importance of a Holistic Approach

Creating an exercise program that integrates functional training, postural control, balance, and strength provides the most effective approach for individuals with cerebral palsy.

• Targets key impairments including decreased stability, impaired motor control, and reduced force production
• Leads to meaningful improvements in functional capacity and movement efficiency
• Enhances performance in tasks such as gait, transfers, and daily activities
• Reduces fall risk and secondary complications such as deconditioning and contracture development

From an exercise physiology perspective, combining these areas supports improved neuromuscular adaptation, enhances independence and quality of life, and promotes long-term adherence to physical activity.