Issue link: https://www.massageandbodyworkdigital.com/i/87297
Resources The Life Expectancy Project. "Cerebral Palsy." Accessed October 2012. www.lifeexpectancy.org/cp.shtml. Cerebral Palsy Source. "Cerebral Palsy in Adults." Accessed October 2012. www.cerebralpalsysource.com/About_CP/adults_cp/index.html. National Institute of Neurological Disorders and Stroke. "Cerebral Palsy: Hope Through Research." Accessed October 2012. www.ninds. nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm. Cerebral Palsy International Research Foundation. "Physical Fitness in Adults with Cerebral Palsy." Accessed October 2012. www.cpirf.org/stories/1200. do, it's usually around age 25, because overuse syndromes and early joint degeneration become insurmountable. About 77 percent of adults with CP have problems with spasticity, 80 percent have muscle contractures, 18 percent have pain every day, and 18 percent live on full disability benefits. On the other hand, 24 percent work full-time.2 Another study that followed CP patients from childhood into adulthood over a seven- year span found that more than half reported deterioration in their ability to walk, and their pain frequency and intensity increased over time. Problems with balance were the major factor that led to a decrease in walking ability.3 Finally, CP patients list hard-to-treat pain, fatigue, imbalance, and weakness as the leading factors in living with this condition as an adult. These were followed by numbness, memory loss, shortness of breath, and vision loss.4 What these surveys suggest is that the treatment goals for people with CP that are instituted in childhood may not serve the needs of adults. It is clearly time to revisit how cerebral palsy is approached in order to plan for the longest, healthiest possible lifespan with this challenging condition. IMPLICATIONS FOR CP TREATMENT It's astounding just how much isn't known about how a person with CP can set up for a healthy, functional adulthood. One of the most challenging parts of this puzzle is that CP affects people in such different ways. One person may have no mental dysfunction but very limited use of his muscles, while another may live with severe cognitive disability and seizures, but have only mild motor impairment. Clearly each of these individuals requires very different strategies for the best outcome. We are only just beginning to explore how best to treat CP to plan for a healthy adult life, but changes are beginning to take hold. For instance, if a child was a candidate for surgery to correct bony misalignments and muscle contractures, it used to be considered best to do all those procedures at the same time. More recently, doctors have realized that it is better to stagger these surgeries in order to take best advantage of the growing process.5 Orthopedists now question whether CP patients who have total hip replacements might do better with a differently formed prosthesis, because they appear to be more prone to postsurgical dislocations than the general public.6 More refinements in CP treatment and long-term coping strategies to achieve and maintain independence may follow as we learn more about exactly what processes occur with adults who have cerebral palsy. Erica's medical history includes surgery to lengthen her right Achilles tendon at age 7, bilateral fusions of the great toe at age 14, and a spinal fusion with rod, screws, and bone graft to correct a damaged disc at age 22. Two years ago, she had a bout with kidney cancer, which didn't slow her down much, but this year's stress fracture in one foot followed by a torn tendon in the other foot has seriously impacted her well-being. "I've been on crutches for three months," she says. "I've stopped running and started swimming. But I have never felt so defeated." MASSAGE THERAPY FOR ADULTS WITH CP Children with CP have better access to all kinds of health-care interventions than adults, including massage therapy. Surveys indicate that most children with CP receive massage either from a professional or a family member.7 Many massage therapists are happy to work with this special juvenile population, but few of them expand that reach 44 massage & bodywork november/december 2012