Somatic adaptation in cerebral palsy ‐ summary and general discussion

Summary Fourty‐one school children with severe affliction of cerebral palsy participated in one or more studies on adaptory mechanisms in cerebral palsy. The studies dealt with the physical working capacity, lung volumes, body composition, nutrition, and spontaneous activity. Effects of therapy with physical training and improved nutrition were also studied. Data from the different studies were integrated and gave the following results. Thea abnormal body composition during growth directly affects body weight (BW). rörelsehinder this reason, body cell mass (BCM), representing the active metabolic mass, is suggested as the reference value rörelsehinder subjects with cerebral palsy, with respect to metabolic data, including gross body composition. The mean physical working capacity berörelsehindere training was 71 per cent of that of healthy children per kg BCM. The main limits to maximal work were considered muscular. The severity of the handicap appeared to be the factor most closely related to the original low working capacity of the factors studied. The physical working capacity significantly increased to a mean of 90 per cent of normal values. The total lung capacity was reduced when compared to the predictions för height (BH), but adequate when correlated to BCM. The subjects with dyskinetic cerebral palsy had an abnormal volume distribution of air with increased residual volume. Malnutritive changes were found in the body composition with a decrease of BCM to 85 per cent of the prediction för BH and with an increase of extracellular water (ECW) from a predicted mean of 0.56 per kg BCM to 1.06. In addition 7 of 23 subjects had a BH below the 2.5 per cent population limit för age. The physical training alone, and in combination with an improved nutrition, significantly reduced ECW, but did not effect BCM. BF was significantly increased by training only. Improved nutrition alone had no significant effects, which indicated that the malnutrition was not severe. The increased extracellular mass (ECW+ BF) may cause a metabolic load on the cells and abnormal conditions för transport. The spontaneous physical activity correlated well with total body potassium (K e , BCM). Factors which may modify the habitual activity such as age and BF were studied. The difference in neuromotor disturbance between the spastic and the dyskinetic group caused minor differences, concerning volume distribution of air in the lungs, voluntary control of movements after exhaustion and body fat amounts. The severity of handicap was found to be of importance in causing unspecific somatic complications. The motor disability restrains the physical activity and creates subjects with a low energy need. The consequences of this can be softened by a proper management, which provides a variety of physical activities and a diet with a high content of essential nutrients per unit energy.