A running training and lifestyle programme for children with cerebral palsy

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Even the most functional children with cerebral palsy (CP) who walk unassisted show limitations of high level mobility relative to their peers. Our clinical experience has been that these children articulate self identified goals around aspects of improving their high level mobility in particular running. In clinical reality these more functional children receive fewer services as they are perceived to be able to participate in aspects of recreation and activity that require higher levels of gross motor function. In daily reality, activity and participation restriction in children with CP who are ambulant exists. There are a number of barriers that may contribute to restricted participation including poor physical capacity to undertake high level mobility tasks proficiently, in particular running. Running is the cornerstone for many individual and team sports and recreational activities, and has been reported to be a significant challenge for individuals with neuromotor dysfunction. There is evidence to suggest that children with CP have lower muscle mass, decreased muscle strength and poorer fitness. Two additional factors worth exploring is whether children have learned the motor components of running and whether they have adapted to a non active lifestyle. It may be that individuals with CP avoid or discontinue membership in sports and recreational activities that require speed and agility due to deficits in running ability. Training programs that focus on teaching the components of running skill in children with CP appear to be unreported. Training the components and skill of running in CP is important for a number of reasons. Firstly, like many determinants of motor change and acquisition of skill in CP, therapy and training to achieve the skill is required. Unlike many therapeutic interventions that address the ability to walk, therapists working with CP rarely address the components in running to the same level. Secondly, running is often identified as a goal of intervention for school aged children, particularly as many school activities are focused around running such as school fun runs, lap-a-thons, daily fitness, general sport. Thirdly, although many interventions have been shown to improve muscle strength, anaerobic and aerobic capacity and even walking capacity in CP, few have demonstrated a translation of these gains into higher level mobility and increases in community participation. We propose to run a three month running skill acquisition and training programme to determine its effect on running skill acquisition, improvement in higher level skill improvements in walking and running capacity and engagement into community programmes and participation. This is important because evidence suggests that physically inactive children are more likely to become physically inactive adults and that encouraging positive physical activity habits in children helps establish patterns that continue into adulthood. The running programme will be run through The Centre for Cerebral Palsy (TCCP) at two of their metropolitan sites. In addition to the running training, a lifestyle aspect will be incorporated into the programme. The lifestyle component will focus on strategies to enable the child or young person to adopt an active lifestyle within their family and school context. This component will include cognitive based coaching and motivational interviewing to coach strategies to practice/continue with the activity related training in the daily situation. The programme will be carried out collaboratively by therapists from TCCP and PMH. The Research Coordinator Physiotherapist from PMH was instrumental in initiating the idea of developing a running skills program, researching the ABI running program model and developing the proposal about how it may be best modified to suit children with CP. In addition PMH has physiotherapists involved in exercise lifestyle models in the obesity related programmes and the eating disorders programs. These PMH therapists have the specialised skills to guide the lifestyle intervention aspect of the proposed running model. This aspect of the intervention differs to that run by Williams and other adult facilities and is grounded in the family context of working with children and young people. It was recognized the programme is best implemented in a community based setting by community providers. Physiotherapists at TCCP have extensive experience and knowledge in community based intervention programmes and working with families in the community. The collaboration of PMH with TCCP will bring together the specialist skills of each of these service providers to benefit the formulation and application of programme.

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