Children with an early neurological problem learn their first movements with a damaged nervous system. Baby brains do recover, but it takes time. It is difficult to study the process of brain recovery in a baby because their brains are also very immature. A newborn uses less than 10% of their adult brain. By age 3 years, the amount of usable brain has only increased to near 30%. Fortunately, the rate of brain recovery in adults with a stroke has been well studied. The first 6-12 months is the period of most rapid recovery of function, with some people demonstrating full recovery. In the second and third year after a stroke, further improvements in motor function are possible, but the rate of change tends to slow down. The adult studies can be interpreted as giving a 2-3 year time window for the primary brain recovery process in humans. There is similar 2-3 year time frame for primary repair of nerve damage such as brachial plexus injury.

It is logical to assume that the young of the human species will follow similar pathways to recovery as the adult human. The key difference with children is, unlike the adult, they have no concept of “Normal”. Babies want to move and they will move using whatever resources are available. These early movements become hard wired into their brains as their own unique walking pattern. No matter how far it deviates from normal to the observer, to them, it feels normal.

Christine learned to walk with her own unique gait and has used this gait pattern into adulthood. Walking independently is a slow process that takes a lot of energy. Although she appears very unsteady, her balancing reactions are quite good and she rarely falls.

For the past two years, Christine has been working with me and a dedicated network of family and friends to change her early walking habit. She has followed a program of rehabilitation that is directed by coaches, therapists and trainers from a variety of health and exercise disciplines. I chose to work with Christine to prove the point that change is possible even in an adult with an early onset problem such as cerebral palsy. She was brave enough to still have hope for change and was willing to commit the time and energy to doing the work of change.

Exercise scientists and coaches understand that it is difficult, if not impossible, to change a habit from within a habit. Equally, it is very hard to change an established walking pattern by walking badly. One of the first and most important techniques for Christine was a water exercise program.

Deep water jogging with a floatation device is a terrific way to train normal reciprocal movements. In deep water, the individual is in a gravity free environment and they have to learn how to move in it. This new environment challenges all the available brain resources and the result is often normal movement, within minutes.

This underwater video clip shows Christine’s legs moving reciprocally. Water provides a gravity free environment and because she is supported by the floatation device, she has no fear of falling. If she tried to move forward with her abnormal habit, she would just turn in circles. The challenge to learn how to move in the water takes her out of her comfort zone, revealing normal leg movements.

Deep water jogging became her core training exercise and a year later, she can jog for 30 minutes straight and moves easily in the water. In this video clip, she has progressed to using water weights on both legs to increase her proprioceptive awareness and further strengthen the normal movement pattern.

Read more about the Basic Water Exercise Program for Gait Training here…

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12 Comments

  1. I strongly believe swimming is one of the best exercises for people with disabilities, especially people with Cerebral Palsy. Doing this swimming program defiantly helps my walking ,talking, and eating. I am more focused at work. i cannot thank Dr Pape enough for introducing swimming to me and I know i can do it for life.. I would highly recommend it for any children and adults with cp. Do the program. It will change your life.

  2. Just wondering how Christine’s gait pattern changed after doing the swimming program for a year? Thanks.

    Answer from Karen Pape
    Thank you for the question. The first change was being able to alternate steps, bringing the right foot up to the left without swinging the leg around. Her on land training now consists of walking reciprocally with a walker and she is transitioning to walking with Nordic walking poles. A post about this will be up next week with videos.

  3. Hi Karen,
    I am 33 years old with Cerebral Palsy; I have done therapy over the years and though I can walk independently, I am prone to falling. Thus I walk with a rollator. I cannot balance when standing for more than a minute; thus when walking unaided, I walk very fast and unsteadily in order to reach my destination before I fall. I have a certain degree of spatiscity. I was wondering whether the deep water jogging would be helpful and whether you could give other recommended exercises for my therapist to do with me to improve my gait and balancing. I’d like to, at the very least, become fully independent on crutches.

    Answer from Karen Pape,
    Farida,
    Thank you for your question. The deep water exercise program is good for any adult who is able to safely get in and out of the water. The Wet Vest is not a life preserver and you should always work out with a buddy for safety. The older you are, the more you need to talk with your doctor before starting this or any other exercise program. The most immediate benefit… in addition to being able to move freely in the water… is improved cardiovascular fitness and strength. I would start with the jogging portion of the program and work up to 30 minutes of jogging. Then add in the exercises at the edge of the pool and walking in chest deep water with a sports barbell – also available from http://www.HydroFit.com – remember to jog in deep water so that you do not hit your feet. If you do touch the bottom, then it activates the old habitual walking pattern. I look forward to seeing some video of you working out in the water.
    All the best,
    Karen

  4. Hi Dr Pape and Christine,

    I am also an adult with CP and was wondering how beneficial this programme would be for me. Although I can walk unaided, I use a rollator mainly because I have the tendency to fall. My gait is a bit different from Christine’s was initially in that I don’t throw my leg all the way out like she did. I am 33 years old and would like to become wholly dependent (at the very least on crutches). If I can get to the point of walking unaided without falling down, all the better. I’ve also done years of therapy but not so much acqua therapy. Could you recommend an exercise programme for me to do with a therapist? If it helps, I could send you a clip of myself walking.

    Many thanks,
    Farida

    Answer from Karen Pape
    Thank you for your question Farida,
    It sounds as if the water program would be useful. You should download it from this site and show it to your therapist and physician. If they are willing, give it a try. The first step is to get comfortable jogging in the water. The Wet Vest is not a life jacket, so you should always have someone with you. It takes most people a week or so to become comfortable jogging. Work up to 30 minutes of jogging in deep water. This will improve your overall fitness and endurance. After the first week or so, start walking in chest deep water, holding on to the barbells shown in the program. You may need the therapist to steady it at first, but then it is just a lot of practice.
    I would love to see a clip of you walking now and as you progress. Good luck with it.
    Best wishes,
    Karen

    • Babies and very young children can splash about in the water with an infant swim vest. Depending on the size of the child, they can fit into a Wet Vest by 3-4 years. By that time, they are old enough to start some more formal training. Fortunately, they just think it is play.

  6. I very much would like to see a video of Christine walking on land after her pool therapy.

    We got a pool at the facility I work. I am so thankful for the videos!

    Lin

    • Hello Lin, This post has Christine walking on a beach with Nordic walking pools.http://www.karenpapemd.com/index.php/moving-from-deep-water-jogging-to-land/
      Re-training her brain is hard because of her age. The walking pattern is firmly in place. It is easier for her to practice in a novel setting. I teach parents that in older children, the walking pattern changes last. You see the extent of recovery in the water when jogging and often when running or moving quickly. Thanks for your comment.

    • Good question. I think gait is a skill that should be trained after you have worked for the best alignment possible with braces and have strengthened the trunk muscles and/or added a compression vest or body suit.Jogging in a Wet Vest is also a great way to both strengthen and train a more normal gait pattern. Hope this helps.

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