Cerebral Palsy

Taken from:
FACT SHEEThttp://www.pecentral.org/adapted/factsheets/CerebralPalsy.htm
And
http://www.cust.educ.ubc.ca/wstudents/TSED/Portfolios1999/Tycho/ubccp/adapt.html

Cerebral palsy is a term used to describe a group of chronic conditions

affecting body movement and muscle coordination. It is caused by damage to
one or more specific areas of the brain, usually occurring during fetal
development; before, during or shortly following birth; or during infancy.
"Cerebral" refers to the brain and "palsy" to muscle weakness/poor control.
Cerebral palsy itself is not progressive (i.e., it does not get worse); however,
secondary conditions can develop which may get better over time, get worse,
or remain the same. Cerebral palsy is not communicable. It is not a disease
and should never be referred to as such. Although cerebral palsy is not
"curable" in the accepted sense, training and therapy can help improve
function.
The Teacher
What is necessary and valuable, more than in-depth knowledge of the disability, is
to be a good teacher. The methods used to include a student with cerebral palsy
(CP) will most likely benefit other disabled and non-disabled students. Teachers of
students with CP:

1. must realize that every child in the class is their responsibility, not a
problem" to be dealt with

2. be flexible: be willing to make accommodations/ adaptations to the

curriculum & materials, their instruction, and to re-write objectives
for a student's needs
3. be able to work in a team
4. be a problem solver
5. believe in the student's ability to learn: although a CP student may
not be able to speak or move fluently, they may be gifted (eg. Christy
Brown)
6. realize that although a CP student may never become fully able to
conventionally perform a skill, it is still valuable for them to learn it
(eg. basketball for students in a wheelchair)
7. recognize that CP students may have high levels of frustration (not
able to communicate, frequently misunderstood, etc.)
 8. remember that the student's attitude to learning is very important --
must try to encourage a receptiveness to learning (class can be
enjoyable and it should be challenging)
9. must differentiate between a student's misbehaviour and what is
disability-related expression by the child
10. Use the resources available; get informed: watch videos, read books,
etc.; communicate with others who have taught CP students

Team Work
Teaching a student with cerebral palsy should be done collaboratively:

1. consult with special education department, speech clinician, instructional

aide, physical therapist, principal, parents, and the student -- work together
to look at academic and therapeutic goals
i. ask questions about the physical & instructional environment, social
interactions, curriculum, etc.
2. consult with the student regularly
3. involve the family

Instruction
Physical Considerations

1. consult with school board physical and/or occupational therapists to

identify the individual needs of a specific student
2. consider posture and movement -- the student's comfort will enhance
their receptiveness to learning; similarly is important that they are
physically receptive to taking in new information
3. Positioning: some CP students may find sitting in a desk
uncomfortable; other positions may be recommended by an aide (eg.
side sitting on the floor) -- consider this during instructional
activities
i. the student must change their position at least every 20-30
minutes (muscular tensions, fatigue, circulation)
4. CP students may have muscular stiffness, and may have difficulty
with head "righting" (focusing on target) or orientation
i. encourage students to stretch
ii. assist child into proper head positioning if necessary, so that
s/he can use a normal arc of vision to view the teacher or
activity (check head & neck alignment)
 5. because of poor motor skills, many CP students will have difficulty
holding onto things (eg.pens, x-acto knives, etc.); learning aides may
assist the student if necessary
6. muscle tightness may result in a student becoming fatigued; a few
students may take naps

Instruction & Student Participation

1. Try to incorporate multi-sensory learning materials {CP students have

limited development in Piaget's "object concept"/sensorimotor period (0-2
years of age)}:
i. audio-visual
ii. tactile (touch)
iii. proprioceptive
2. "learning requires the active participation of the learner" : encourage
discussion and active participation (statistics show that CP students are
given few opportunities to participate)
i. if possible, lab work, hands-on experience, creating something
themselves
ii. don't do everything for them if they can do some things by
themselves
iii. students can use any method, from speech to augmentative
technology to eye-pointing, to communicate in the classroom
iv. writing, if not possible by the student (or if spech-to-text
software is not available) is usually done thru an aide
3. allow time for responses (at least 5 seconds)
i. doing this will encourage participation & multi-word answers
ii. ask open-ended as opposed to yes/no questions
iii. encourage the student to use their augmentative device if available
(over head nodding) -- some students will not be proficient with the
technology
iv. don't fill silence gaps between your question and the student's
response
4. "learning is a social and individual process": peer and teacher interaction
with the student should be a priority: cooperative learning, peer tutoring,
discussion
i. students need to succeed socially; include them in group activities,
encourage peer interaction
ii. to teach social and communication skills, the teacher will serve as a
model for the student
5. choose learning activities, not simply to keep CP students busy or for
evaluation purposes, but because it helps them learn & has educational value
6. be cautious of how much time is being spent on instruction, and how much is
being lost to transitions, technology concerns/ repairs, therapies, toitleting,
etc.
7. use better management & preparation to prevent interruptions or delays --
if interruptions do occur, give the student an independent activity to engage
in while the teacher is busy with management activities

Curriculum

1. create a specific curriculum considering student's needs and that

involves the student
2. get student input & let student help establish an academic program.
Ask the student:
1. is the work too hard/easy?
2. is the pace too fast/slow?
3. what teaching methods they prefer
3. provide opportunity for student choice (eg.let them select certain
books to read, or give them a choice of topics, etc.)
4. consider the student's interests & their internal motivation to
develop needed skills
5. find out what skill level they are at; don't make assumptions; build on
their strengths
6. figure out what skills a CP student needs -- go beyond the
standardized curriculum
7. keep high expectations
8. any curriculum should encourage active participation, discussion,
cooperative learning
9. structure the curriculum and activities to allow the students to
experience success, and demonstrate their competence
10. recognize that everyone is working toward a common goal; not
everyone has to be doing the same thing
11. Assessment: don't time tests or give students longer to complete it;
mark with different criteria if the student's disability puts them at
an unfair disadvantage
12. consider accessibility/transportation (esp. with field trips, out of
class assignments)

Technology
1. 85-95% of CP students have a speech disability; 30% have
severely limited speech which cannot be easily understood.
Students may use:

i. Digitized Speech Generator (Chat Box, Liberator)

ii. Bliss Board
iii. Eye Movement Recognition Hardware

1. some devices do not match cognitive ability

2. it is important for teachers to become generally familiar with
the devices
3. augmentative: not education itself, but a tool to facilitate
education (a means to an end)
i. the teacher needs to see the student behind the
technology
4. books on tape; written instructions on tape or orally
5. computers:
i. text-to-speech; speech-to-text (multi-sensory)
ii. large fonts/ display
iii. non-standard keyboards: single keystrokes=
frequently used words
6. technology may need to be adapted for each classroom
(entering in new vocabulary onto a board)
 TYPES OF CEREBRAL PALSY

Spastic cerebral palsy. In this form of cerebral palsy, which affects 70 to

80 percent of patients, the muscles are stiffly and permanently contracted.
Doctors will often describe which type of spastic cerebral palsy a patient
has based on which limbs are affected, i.e spastic diplegia (both legs) or left
hemi-paresis (the left side of the body). The names given to these types
combine a Latin description of affected limbs with the term plegia or
paresis, meaning paralyzed or weak. In some cases, spastic cerebral palsy
follows a period of poor muscle tone (hypotonia) in the young infant.
Athetoid, or dyskinetic cerebral palsy. This form of cerebral palsy is
characterized by uncontrolled, slow, writhing movements. These abnormal
movements usually affect the hands, feet, arms, or legs and, in some cases,
the muscles of the face and tongue, causing grimacing or drooling. The
movements often increase during periods of emotional stress and disappear
during sleep. Patients may also have problems coordinating the muscle
movements needed for speech, a condition known as dysarthria. Athetoid
cerebral palsy affects about 10 to 20 percent of patients.
Ataxic cerebral palsy. This rare form affects the sense of balance and
depth perception. Affected persons often have poor coordination; walk
unsteadily with a wide-based gait, placing their feet unusually far apart; and
experience difficulty when attempting quick or precise movements, such as
writing or buttoning a shirt. They may also have intention tremor. In this
form of tremor, beginning a voluntary movement, such as reaching for a
book, causes a trembling that affects the body part being used and that
worsens as the individual gets nearer to the desired object. The ataxic form
affects an estimated 5 to 10 percent of cerebral palsy patients.
Mixed forms. It is not unusual for patients to have symptoms of more than
one of the previous three forms. The most common mixed form includes
spasticity and athetoid movements but other combinations are also possible.

CHARACTERISTICS

Underdeveloped motor skills

Slow to reach developmental milestones (rolling over, sitting, crawling,
smiling, walking)
Abnormal or vacillating muscle tone
Decreased muscle tone- Hypotonia
Increased muscle tone- Hypertonia (stiff and rigid)
May favor one side of the body or one movement pattern
Unusual and often awkward posture
 May walk on tip toes or may carry arms high in high guard position for
balance
May focus locally on surroundings and not view the larger play area may
demonstrate poor visual acuity
When under age 3 may demonstrate difficulty with head control and older
may hold head in awkward position
Possible seizures and tremors often take medication to reduce frequency

CAUSE

A large number of internal and external factors can injure the developing brain and
may lead to cerebral palsy or cerebral palsy like conditions. One identified cause of
cerebral palsy is an insufficient amount of oxygen reaching the fetal or newborn
brain. Oxygen supply can be interrupted by premature separation of the placenta
from the wall of the uterus, awkward birth position of the baby, labor that is too
long or too abrupt, or interference with circulation in the umbilical cord. Premature
birth, low birth weight, RH or A-B-O blood type incompatibility between mother and
infant, infection of the mother with German measles or other virus diseases in early
pregnancy, and microorganisms that attack the infant's central nervous system also
are risk factors for cerebral palsy. Most causes of cerebral palsy are related to
the developmental and childbearing processes and, since the condition is not
inherited, the condition is often called congenital cerebral palsy. A less common
type is acquired cerebral palsy, usually occurring before two years of age. Head
injury is the most frequent cause, usually the result of motor vehicle accidents,
falls, or child abuse. Another possible cause of post child bearing cerebral palsy
like conditions include severe brain infection.

ETIOLOGY AND PROGNOSIS

Cerebral Palsy is not a progressive disorder. A person with the disorder may
improve somewhat during childhood, if they receive extensive care from specialists.
Some individuals with the disorder will need to stay under the immediate care of
another person for their entire lives, while others have a mild enough case to
pursue fully independent lives.

ASSESSMENT SUGGESTIONS

Authentic Assessment- Testing that provides the teacher with the needed
information to develop a meaningful physical education program
 Criterion- Referenced Test- Determine whether a skill has been mastered,
it is not compared to other students in the class.

RECOMMENDED ACTIVITIES

Stretching: Stretching of muscles is done by moving the arms or legs in a

way that produces a slow, steady pull on the muscles to keep them loose.
Children with cerebral palsy have increased tone and tend to get very tight
muscles. Therefore, it is extremely important to perform daily stretches to
keep arms and legs limber so the child can continue to move and function.
Strengthening: Strengthening exercises work specific muscle groups to
enable them to support the body better and increase function.
Positioning: The body is placed in a specific position to attain long stretches.
Some positions help to minimize unwanted tone. Positioning can be done in a
variety of ways, including: bracing, abduction pillows, knee immobilizers,
wheelchair inserts, sitting recommendations, and handling techniques.

Riding a specially adapted tricycle can be very exciting and provides excellent
exercise. An outdoor activity that can benefit almost any child with cerebral palsy
is swimming. Not only does swimming give children a freedom of movement they
dont have on land, but it can also help improve respiratory ability. It is important to
note that cold water can increase muscle tone, but warm water often has a relaxing
effect and help reduce muscle tone. This means you should look for a pool with a
water temperature best suited to the childs tone. Other activities you may want to
investigate include therapeutic horseback riding and Special Olympics/Paralympic
opportunities.

EFFECTIVE TEACHING STRATEGIES

Work on muscle stretching and reduction of tone (work closely with PT)

Gross motor skills to include those that work away from midline (e.g. sliding)

Modify equipment:
o use ball sacks, balloons or beach balls
o modify rules of games
o enlarge targets
o use large scooters
o extensions for tag games
 Always consider safety issues, make sure the class understands the rules
and modifications of activities. ALWAYS include a student with any
disability in the class, do not leave them standing on the sideline.

Students with cerebral palsy do not always demonstrate appropriate use of

reflexes, especially protective and postural reflexes found with typical
development.

RESOURCES

http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm

Cerebral Palsy Multimedia Tutorial

http://hsc.virginia.edu/cmc/tutorials/cp/cp.htm
Excellent multimedia description of a child's life with cerebral palsy. Therapy,
equipment and problems are described along with more personal topics.

CP Parent List Archives

http://maelstrom.stjohns.edu/archives/cpparent.html
Publicly accessible archives for the CP Parent listserv are a great resource for
parents who wish to catch up on discussions on the list or search for a particular
topic.

United Cerebral Palsy (UCP) Research Fact Sheets

http://www.ucpa.org/ucp_generalsub.cfm/124/4/24
Summaries of research on cerebral palsy covering a number of years - informative
but easy to read.

Scope
http://www.scope.org.uk
Scope is the United Kingdom's largest charity providing support and services for
children and adults with cerebral palsy, their families and carers. Online articles
address lifestyle issues such as cerebral palsy and aging and cerebral palsy and
pregnancy.

REFERENCES

http://www.asdk12.org/Depts/ape/common/cerebralpalsy.html

http://en.wikipedia.org/wiki/Cerebral_Palsy
http://www.ndsaonline.org/

http://gait.aidi.udel.edu/res695/homepage/pd_ortho/clinics/c_palsy/cpweb.htm