PT Corner: Looking at the Differences between Exercise and Function in Treatment

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by Natan Gendelman, PT

As we’ve mentioned before, cerebral palsy is a complex disorder that comes to affect not only a child’s muscles, but his entire body and its ability to function. I often emphasize how the trunk is the king of the body, and that is because the tone of the limbs will be influenced by the trunk. When we’re dealing with a child that has cerebral palsy, his trunk may become stiff (hyper tone), which then moves on to affect other areas such as his arms and legs. Therefore, the condition of the trunk has to be addressed first, and the extremities (such as the arms and legs) second.

The developmental stages
So how does the trunk develop? According to a child’s developmental stages, the first thing that he learns is to move his head and eyes, followed by rolling from side to side. A child rolls from side to side in order to enhance the function of the trunk, which precedes the following stages of sitting, crawling, standing and walking. That is why it is important to teach a child with cerebral palsy functions which are appropriate for his age and stage of development. If a child cannot roll, then he will not be able to sit up on his own (from lying down to sitting up). This causes a chain reaction to occur, because once he misses one stage of development, he will not be able to progress to the next step.

Looking at function vs. exercise
Now, there is a huge difference in the ways you can go about developing a child’s physical capabilities. In one of the emails I received regarding our last blog, someone asked me a question about my thoughts on exercise and how it differs from function.

In our daily lives, it is common for someone who works out to go to the gym and exercise for a couple hours per day. Sure, it can be beneficial–but this kind of passive exercising doesn’t connect with our daily function and what we do. When I talk about function, I am referring to actions which are performed with a certain practical goal in mind. Whether we walk, reach for something, or speak, what makes them different from the act of exercising is that these are all actions which are used in our everyday lives.

When a child goes through the stages of development, he is not exercising. Instead, he is reaching, achieving, and exploring the world for himself. This process isn’t something that goes on for just 1-2 hours a day during your child’s therapy sessions. It is consistently happening 24 hours a day, every day. Even as a child sleeps, he is learning because he is rolling and touching things unconsciously, stimulating his senses in the process. Therefore, it is important to show him how to apply what he learns in his daily life, so that every moment is an opportunity for him to grow rather than a repetition of actions performed with no intent in mind.

The real goal
Of course, with all things said the goal of any treatment is to successfully get a child to function well in his daily life. Ultimately, his treatment shouldn’t just be about reinforcing a his trunk, or strengthening his muscles. Instead, the entire point of his treatment is to get him to become independent. To do that, our job is to teach him how to function. At the clinic, our principle is that a child should work and do things by himself, for himself. The general mentality is that if he wants it, he has to get it rather than rely on others to do it for him. Parents can help him if he needs it, but should not be doing things in his stead.

Once a child begins doing and applying the same function in various situations by himself, he will start to realize that what he has learned is a part of his daily life. This is what parents and therapists work to achieve. Therefore, my philosophy is that there are no exercises; just function. By keeping these words in mind, we encourage our kids to participate and thereby achieve independent function.


About the Author:  Natan Gendelman, PT

Natan Gendelman is licensed as a physical therapist in Russia and Israel. After moving to Canada, he was certified as a kinesiologist and osteopathy manual practitioner. Natan has more than 20 years of experience providing rehabilitation and treatment for conditions such as cerebral palsy, autism, Down syndrome, pediatric stroke and acquired brain injury. He is the founder and director of Health in Motion Rehabilitation, a Toronto-based clinic whose main objective is to teach their patients the independence necessary for success in their daily lives.

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