This case study focuses on the physical therapy management of Kayla, a young woman with spastic, diplegic cerebral palsy (CP). Kayla is now a 29-year-old college graduate who was recently married (Fig. 18.1). She was born prematurely and has received physical therapy services in a variety of settings since infancy. She has been followed for early intervention, early childhood, school-based, outpatient, and home health physical therapy services. At this time, she does not regularly see a physical therapist. Kayla walks in her home setting and in the community using bilateral forearm crutches. For longer distances, she uses a motorized cart.
Newlyweds dancing at their wedding reception. (Courtesy of David Gold.)
CP “describes a group of permanent disorders of development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances in sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems” (Rosenbaum et al., 2007, p. 9). Children and young adults with CP are reportedly less socially and physically active than their peers without a physical disability (Carlon, Taylor, Dodd, & Shields, 2013; Engel-Yeger, Jarus, Anaby, & Law, 2009; Maher, Williams, Olds, & Lane, 2007; Shikako-Thomas, Majnemer, Law, & Lach, 2008). Adults with CP are also less likely to achieve recommended amounts of daily physical activity (Usaba, Oddson, Gauthier, & Young, 2015). Individuals with CP frequently present with impairments of range of motion (ROM), soft tissue mobility, strength, coordination, and balance, resulting in motor control difficulties.
Although the cortical lesion is nonprogressive, as the infant grows and strives to become more independent, functional limitations become more apparent, as do restrictions in activities and community participation. Secondary impairments in body structures and function, such as ROM limitations, disuse atrophy, and impaired aerobic capacity, may further limit functional motor skills and ability for activities and participation. Multiple episodes of physical therapy management are frequently warranted as the child attempts more complex functional skills and as the risk for secondary impairments increases. The goal of physical therapy intervention for children and young adults with CP is to maximize the individual’s ability to participate in age-appropriate activities within the home, school, and community settings. The therapist should also include activities that will best support transition into adulthood.
As children with CP reach adulthood, they are at increased risk of developing chronic conditions such as hypertension, asthma, joint pain, arthritis, and other lifestyle-related chronic conditions (Cremer, Hurvitz, & Peterson, 2017; Peterson, Ryan, Hurvitz, & Mahmoudi, 2015). This increased risk appears to be related to age, levels of sedentary activity, level of disability, and increased adipose tissue (Cremer et al., 2017; ...