FEATURES OF BODY COMPOSITION OF ADULTS WITH SEVERE CEREBRAL PALSY

T. Matsuda¹, Y. Akezaki², Y. Tsuji³

¹Suita Municipal Disability Support Center I-Hope Suita, Department of Rehabilitation, Suita, Japan, ²Kochi Professional University of Rehabilitation, Division of Physical Therapy, Kochi, Japan, ³Kansai University of Welfare Sciences, Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kashiwara, Japan

Background: People with cerebral palsy (CP) have a group of disorders affecting the development of movement and posture, causing limitations to their activity. These disorders are attributed to nonprogressive disturbances in the developing fetal or infant brain. Many children, adolescents, and adults with CP have reduced cardiorespiratory endurance, muscle strength, and habitual participation in physical activity (PA). Although there are reports on the participation status of CP in PA and recommendations of PA, the benefits of various approaches for initiating and administering a progressive activity program for individuals with CP classified at Gross Motor Function Classification System (GMFCS)levels IV and V have not been systematically evaluated.
A lack of exercise is thought to be the foremost risk factor for sarcopenia. The cut-off value for muscle mass is clear for men and women. However, the body composition of people with severe CP has not been clarified. It may be useful to measure body composition of people in this group to help in the development of an activity program suitable for individuals with CP of GMFCS level V.

Purpose: The segmental extracellular water (ECW): intracellular water ratio has attracted attention as a measure of muscle quality. The purpose of this study was to measure the skeletal muscle mass and water content in the limbs of adults with CP classified as GMFCS level V, to confirm this feature of their body composition and the natural course of their condition.

Methods: The participants were 11 individuals with severe motor and intellectual disabilities due to CP and who had been diagnosed with a neurological impairment that affected their central nervous system. The survey period was 6 months. For body composition, the skeletal muscle mass index (SMI) and ECW/total body water (TBW) were measured using a body composition analyzer, InBodyS10 (In Body Co., Ltd.). To understand the changes of natural course, SMI and ECW/TBW were measured three times in total: at the start of the survey, after 3 months, and at 6 months.

Results: Over the 6-month survey, ECW/TBW levels in the participants’ trunks and lower limbs had increased at 3 months and 6 months compared with their levels at the start. Although the SMI did not show any significant changes throughout the study period, it was found to remain very low.
The mean ± standard deviation of the SMI for a total of three measurements was 2.86 ± 0.09 kg/m². This was significantly lower than the reference valuefor sarcopenia.

Conclusions: Individuals with CP and severe motor disabilities were found to be already in an edematous state and had very little muscle mass. The characteristics of the natural course of body composition were considered to be the exacerbation of edema and loss of muscle mass, especially in the trunk and lower limbs.

Implications: Although it is difficult for these participants and others with similar conditions to participate in PA, it is important that physical therapists play a role in enhancing light PA and reducing the time such individuals remain sedentary.

Funding acknowledgements: This work was unfunded

Keywords:
Severe cerebral palsy
Body composition
Sarcopenia

Topics:
Paediatrics: cerebral palsy
Health promotion & wellbeing/healthy ageing/physical activity
Musculoskeletal

Did this work require ethics approval? Yes

Institution: Kochi Professional University of Rehabilitation

Committee: Ethics Review Committee

Ethics number: R2-3