# Impact of Exercise Modalities on Upper Extremity Spasticity in an Adult with Quadriplegic Cerebral Palsy: A Case Report

## TL;DR

This case study explores how different types of exercise affect upper body spasticity in an adult with cerebral palsy, finding aquatic exercise most effective.

## Contribution

The study provides novel evidence on the comparative efficacy of three exercise modalities for reducing upper extremity spasticity in quadriplegic cerebral palsy.

## Key findings

- Aquatic exercise showed the greatest reduction in spasticity (MAS score decrease of 0.67).
- Hand cycle bike exercise had moderate effectiveness with a spasticity reduction of 0.39.
- Weight-resistance exercise showed the least impact with only a 0.20 reduction in spasticity.

## Abstract

Background: Spasticity, a hallmark of quadriplegic cerebral palsy (CP), severely impacts mobility and quality of life. While exercise is known to enhance fitness and motor function in individuals with CP, its specific efficacy in reducing upper extremity spasticity remains insufficiently studied. This research investigated the effects of weight-resistance exercise (RE), hand cycle bike exercise (BE), and aquatic exercise (AE) on upper extremity spasticity in an adult with quadriplegic CP. Method: The participant was a 35-year-old individual with quadriplegic spastic CP, presenting severe spasticity in the right upper extremity and lower limbs, and milder left arm involvement. Dependent on a power wheelchair, they were cognitively intact, college-educated, and had participated in a community exercise program for five years. Over nine weeks, the participant completed 18 sessions—6 per modality of RE, BE, and AE—with each session held twice weekly for 50 min. Spasticity was assessed using the Modified Ashworth Scale (MAS) before and after sessions, with comprehensive pre- and post-intervention evaluations. Result: Total MAS scores decreased significantly from 2.76 to 2.33 (p < 0.05). AE yielded the largest reduction (2.81 to 2.10), followed by BE (2.75 to 2.36) and RE (2.72 to 2.54). ANOVA confirmed AE’s superior efficacy (F(2,15) = 27.20, p < 0.001, ηp2 = 0.78), with a 0.33 reduction overall. Conclusions: AE was most effective, likely due to buoyancy, followed by BE, with RE showing the least impact. These findings highlight aquatic interventions as promising for spasticity management in CP, necessitating further longitudinal, multi-participant research.