Working Diagnosis:
According to the literature review, athletes with cerebral palsy are at increased risk for overuse syndromes, muscle strains, chronic knee pain, patellofemoral problems, and chondromalacia.

However, one study was reviewed that analyzed athletes with cerebral palsy. It concluded that injury incidence and patterns are similar for athletes with and without disabilities.

Another 3-year cross-disability study reported an injury rate of 9.30 per 1000 athlete exposures (defined as 1 athlete participating in 1 practice or game in which there is the probability of sustaining an athletic injury), a rate similar to other non-disabled sports.

Additionally The United States Cerebral Palsy Athlete Association uses a classification system, which ranges from class 1 to 8 where athletes are grouped to compete only against athletes with their same classification.

Class 1: Severe involvement in all four limbs with poor functional strength in upper extremities, often necessitating the use of an electric wheelchair for independence.
Class 8 is an athlete whose function is minimally affected and is able to run and jump freely and has good balance.

Given this classification system, C.O. was clearly a class 8.

Treatment:
Given the patient's high level of functioning, normal gait, and risk of injury equal to an athlete without physical limitations, C.O. was cleared to participate.

Outcome:
C.O.'s case posed an interesting question to the sports medicine staff. Can a high-finctioning athlete with a musculoskeletal disorder be at significant risk for injury and be prohibited from participation?

Based on the review of available data and the additional review of her medical records, the sports medicine team felt the patient was at no additional risk of injury compared to athletes without cerebral palsey. It was determined that she should not be disqualified from participation.

One problem with the data review was that most of the available research was done reviewing risk of injury in athletes with disabilities who compete against other athletes with disabilities.

The final determination to clear the patient for participation was made based primarily on her high functioning status and her symptom-free participation in high school athletics.

To date C.O. has participated in cross country and lacrosse and has remained injury free.

References:
1. Paneth, et al, Proposed Definition and classification of Cerebral Palsy. Developmental Medicine & Child Neurology 2005, 47: 571–576
2. Engel-Yeger,, et al, Differences in Patterns of Participation Between Youths
With Cerebral Palsy and Typically Developing Peers. The American Journal of Occupational Therapy. January/February 2009, Volume 63, Number 1
3. Morris. Physical Activity Recommendations for Children and Adolescents with Chronic Disease. Current Sports Medicine Reports. V 7 N. 6 November/December 2008
4. Patel, Greydanus. Sports Participation By Physically and Cognitively Challenged Young Athletes. Pediatr Clin N Am 57 (2010) 795–817
5. Carroll, et al. Cerebral Palsy: Physical Activity and Sport. Current Sports Medicine Reports 2006, 5:319 –322

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