Topic: Cerebral Palsy
Researched and written by:  Jennifer Hunt
                                                I attest that the following report is a product of my own original work.

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Summary
 

Overview of Cerebral Palsy Cerebral Palsy is defined as a group of chronic symptoms that affect the movement of the body, and is often found early in life.  It also creates problems with muscle coordination, vision problems, mental retardation, and sometimes behavioral problems (Scholtes, 2002).  Cerebral Palsy is caused by damage to the brain, and usually becomes apparent during development of the fetus, shortly after birth, or while the child is still an infant.  This damage to the brain is what causes the person to have impaired motor skills and speech (http://ucp.org/).  The term Cerebral Palsy comes from “Cerebral” meaning the brain and “Palsy” meaning impaired muscle control (http://ucp.org/).  Brain damage from this disability does not become worse, but the muscles can continue to weaken further, thus making the disability worsen.  This is not a curable disability, but with therapy the effects can be lessened (http://ucp.org/).             The discovery of Cerebral Palsy came about in the 1860’s when a surgeon named William Little talked in one of his medical journals about a disorder that caused stiffness in children’s muscles, and they did not get better or worse as they grew up.  Little said that the cause of these muscle problems was a lack of oxygen.  In 1897 Freud examined this conclusion and disagreed.  He said that Little was wrong because it was just not muscle problems that these children had; he said that they also were experiencing mental retardation, vision problems, as well as seizures.  More research was done in the 1980’s to continue learning about the causes of Cerebral Palsy (http://ucp.org/) Statistics for Cerebral Palsy             According to United Cerebral Palsy, the latest statistics are that at least 764,000 children and adults show at least one symptom of the disability.  More than 100,000 Americans who are under the age of 18 are thought to have some type of impairment that is related to Cerebral Palsy (Katz, 2003). Of those 100,000 people there are four categories that the children are put into.  The first category is the most prevalent, called the spastic category, which comprises about 70% of children with the disability.  Spastic syndromes generally affect the limbs; it can affect one or both legs, one or both arms, or all four limbs, and makes the muscles stiff or permanently weak.  The next category is the athetoid category and that comprises about 20% of the group.  People who show signs of Athetoid syndromes often have slow involuntary movements, and sometimes may have jerky movements.  People who are experiencing this type may have trouble with their hands and limbs and possibly even the tongue and muscles in the face which can cause the person to drool.  The third category is Ataxic and this comprises only 10% of the group.  This is something that is very uncommon.  People in this group may have coordination problems and tremors.  These people have trouble walking and they have a tendency to place their feet apart.  They also have trouble with specific movements such as tying a shoe.  They also have trouble making quick movements.  Most people fall into the mixed group which deals with having a combination of the symptoms (Katz, 2003).  The most common in the mixed group is mixing the spastic syndrome with the athetoid syndrome. About 8,000 infants are diagnosed with the disorder every year, and 1,200 to 1,500 preschool age children are diagnosed each year (http://ucp.org/).  There is no information to show that one race or gender is more likely to be affected by Cerebral Palsy.  Cerebral Palsy has not been found to be genetic.   Characteristics of Cerebral Palsy             Cerebral Palsy does not have only one cause because it is a group of disorders with many causes.  One type of Cerebral Palsy is Congenital Cerebral Palsy, and it comes from having a brain injury while in the womb.  Children may also get Congenital Cerebral Palsy during the time that they are being born.  Congenital Cerebral Palsy is the cause for 70% of children with the disability (http://ucp.org/).  Some children may acquire this disability due to head injury or brain infections such as meningitis.  Some risk factors for Cerebral Palsy are low birth weight, premature birth, lack of oxygen or nutrients while in the womb, incompatible blood type with the mother, or if the mother gets some type of disease (http://ucp.org/).              Cerebral Palsy can not be cured, but in some cases it can be prevented.  One way to prevent Cerebral Palsy is to make sure that the child wears a helmet when riding a bike and sits in a child safety seat.  Head injuries are one of the leading causes of Cerebral Palsy.  Small children sometimes can get Jaundice. This can come from blood cells being destroyed and then yellow pigments build up that cause Jaundice.  This can cause brain damage leading to Cerebral Palsy if left untreated.  One treatment that is out there for Jaundice is called phototherapy.  Phototherapy is where the child is exposed to bright blue lights that break down the harmful pigments so that they do not cause harm to the brain, and if that is not enough then the doctors can give a blood transfusion.  Another way that Cerebral Palsy may be prevented is by giving the mother and the father blood tests before becoming pregnant to see if the parent’s blood types are compatible so that the baby does not have one that is not compatible with the mother.  If the blood types are not compatible then the doctor can take some of the babies’ blood while still in the womb and have it ready if the baby needs a blood transfusion after birth.  One final way that Cerebral Palsy may be prevented is to make sure the mother is vaccinated for Rubella and German measles so that the baby does not contract it.  Along with all of these it is important for the mother to have a healthy diet, take prenatal vitamins, and have regular check ups at the doctor while pregnant (http://www.ninds.nih.gov).             One study that was done by the National institute of Neurological Disorders and Stroke organization looked at babies that were born at very low birth weights.  Scientists think that by giving mothers magnesium while pregnant can help to prevent the baby from being born early, as well as preventing the mother from having high blood pressure.  Scientists also think that by giving magnesium to the mother it can help to prevent bleeding in the brain of the infants and help with brain development.  However, pregnant women should not increase their magnesium intake because it has not been shown what high doses of magnesium will do to the infant.  Magnesium should only be given at the hospital intravenously if needed (http://www.ninds.nih.gov). There are three classifications for Cerebral Palsy.  The first classification is Hemiplegia, which has to do with impairments with one arm and one leg on the same side of the body.  Diplegia deals with impairment of both of the legs.  The last type is Quadriplegia which makes all four limbs impaired and the neck and other muscles (http://gait.aidi.udel.edu/). There are a few disabilities that may look similar to Cerebral Palsy.  Some of these disorders are muscular dystrophy, muscle and nerve disorders, Tay-Sach’s disease, and chromosomal disorders (http://gait.aidi.udel.edu/).  Diagnosis for this disorder can be found by going to see your pediatrician.  Cerebral Palsy is diagnosed by looking at the developmental milestones for the child and seeing if they are on target with the age range that is specified.  For example at three to four months a child should be reaching for toys, at six to seven months they should be sitting, and at ten to fourteen months they should be walking.  Along with looking for delays in the developmental milestones the pediatrician will also look at the child’s muscle tone, reflexes, and the movements that the child is making.  Most diagnoses are not made until the age of eighteen months to see if the child catches up to where they should be developmentally.  One test that may be done to see if a child may have Cerebral Palsy is an MRI.  This is done to look at the child’s brain to see if there are any abnormalities (http://gait.aidi.udel.edu/). One very noticeable characteristic of Cerebral Palsy has to do with motor skills.  A child with Cerebral Palsy may refuse to bear weight on their legs, stand, or even walk by the age of two (DiMario, 2003).  The child may also have difficulty holding their heads up. Farmer (2003) said that if a child is not able to sit independently by age two then the chances of the child being able to walk is poor.  Children may also have trouble with language development. Early signs for Cerebral palsy are usually seen before 18 months of age.  Some of these signs may be that the child is having trouble rolling over, smiling, crawling, or even walking.  Some children may have decreases in muscle tone as well.  Children may also have trouble eating or swallowing.  Children with Cerebral Palsy may have trouble with incontinence because their muscles are not strong enough to maintain bladder control (http://www.ninds.nih.gov).  An early marker for Cerebral Palsy is that preterm infants have cramped general movements.  Reading (2002) observed 84 preterm infants to see if Cerebral Palsy may in fact be present.  These infants already had a brain lesion that was detected when they were given an ultrasound.  The results of his study showed that 33 of the infants showed cramped general movements and they all developed Cerebral Palsy (2003).  The main characteristic of Cerebral Palsy is trouble with motor skills. Classroom Issues Disabilities such as Cerebral Palsy affect the classroom in a few ways.  One way that the disability affects the classroom is that under IDEA (the Individuals with Disabilities Education Act) all children with disabilities are entitled to a free and appropriate education.  This may require teachers, principals, counselors, school psychologists, special education teachers, family members, and possibly even the student, if they are old enough, to come up with an IEP (Individual Education Plan).  This plan gives specific goals for the child dealing with their educational needs and how they plan to overcome them.  Every few months this plan is reviewed to see how the child is progressing.  The parents are to approve and be informed of the entire process (Turnbull, Shank, and Smith, 2004).  If the school decides not to work with the child, or the parent sees that the plan is not being followed then it is their right to be able to take the school to a court of law.  There are a few issues that may be detrimental in the learning process for children with disabilities.  One of those problems is that the child may be sent into a resource room to learn for part of the day.  By sending the child into another room away from the other students could be setting him or her up for problems.  They could end up being ridiculed by the other students, or if they have someone who gets frustrated easily and is not willing to work with them, then the student may not be getting the education that is needed.  Another problem is that by sending the child to the resource room it prevents them from creating relationships with the other students, working on verbal skills, and possibly motor skills (Turnbull et al, 2004).  One example of a child not being able to work up to their full potential is shown in an article written by Reis (2002).  She wrote about how one researcher, Willard Holt, saw that two students with Cerebral Palsy were gifted, but not able to show their full potential.  These two students were not able to speak, but showed advanced math and verbal skills, they were quick to learn, had a sense of humor, a desire to be independent, were very motivated,  and they knew what their limitations were.  The problem was that the teachers were only focusing on what areas they were weak in rather than what the student’s strengths were. One option, other than using a resource room, is to have a paraprofessional help the student.  This is not always the best solution and can still create stigmas for the students.  In some cases using a paraprofessional is seen to be beneficial to the student.  One such case is the case of Thomas, a 9 year old boy with Quadriplegia Cerebral Palsy.  Thomas was introduced to a program called AAC (augmentative and alternative communication) at the age of 3½.  Then at age 6 he had therapy to help his language, and at 7 he got his first talking screen.  Thomas’ screen did the talking for him.  Then at the age of 9 Thomas was put into a general classroom with the help of a paraprofessional.  She continued therapy with him during the day, but he was able to be with the other students with the aid of the paraprofessional, his speaking screen, and a magnifying glass (Blischak, 1995).  The best method for giving a child an equal education is full inclusion.  The premise of this method is to give the child everything he or she needs to provide them an education in the general classroom.  This would have all students gifted, disabled, and other students in one classroom learning together.  One way to accomplish this is to have at least two teachers in every classroom.  The teachers should be trained in special education as well as general education.  By having two teachers in one classroom you are allowing extra help to the students and also allowing collaboration to happen.  One teacher can be in the classroom teaching while the other is in a meeting trying to figure out better teaching strategies and how the school itself may be doing.  Students can benefit from this plan as well, because it allows for the possibility of peer tutoring, and also teaches the other students about disabilities and giftedness.  It may create better communication and friendships between students as well as tolerance (Turnbull et al, 2004). Volkmann (1978) found that there are a few strategies to help with implementing inclusion in elementary schools.  One way is that if a child is confined to a wheelchair you could have them be a referee for a game so they are included, or have them make up their own game so that they can play to.  Children with Cerebral Palsy are often looked over and teachers are not sure how to include them so they are put into resource rooms or other programs, and sometimes even special schools all together.  One way to get children to understand about the disability someone has is to explain to them what it is and how it is caused.  The children must be informed that the disability is not the fault of the child who has it and not to laugh at them but to encourage them and help them when they need it.  When holding the discussion, this allows the other children to ask questions so they are fully informed about the disability. Treatment Issues as they relate to the Classroom             Cerebral Palsy is not something that can be cured; although with proper therapy and someone to be there to work with the student the effects of Cerebral Palsy can be lessened.  Blundell (2003) studied one way to help children who are experiencing Cerebral Palsy is through a strength training course.  This course was designed for children from the ages of four to eight.  There were eight children who participated in the study.  These children signed up to go to a four week after school exercise program in where they went twice a week for an hour at a time.  The children were to move between the stations as they exercised.  Some of the stations were the treadmill, walking, step ups, leg presses, and sit to stand.  There was a test two weeks before the training to see where the students stood in their physical ability and one right after the training to see if they had improved or not.  The students had improved in all categories.  Another test was given eight weeks after the training and the students had maintained their improvements.  If some type of program could be implemented in schools, not just for children with Cerebral Palsy, but for all children, there is a chance that all students would benefit and become healthier and have better motor skills.              Parks (2002) found that Physiotherapy is another way to help children in the classroom.  Physiotherapy is basically the same as physical therapy.  It incorporates the combination of exercise and massage to help the person with the disability.  A study was done to see how many parents of children with Cerebral Palsy actually used physiotherapy.  There were 212 parents who were surveyed about their children, ages 4-14, to see how many used it.  The results showed that 96% of the children received physiotherapy during school and 59% of those were receiving treatment at least twice a week for a 30 minute period.  One problem was that 43% of these children had their treatments discontinued over the summer months.  If it is possible that by setting up some sort of program within the school or the community to give physiotherapy to these children, then perhaps some of them may be able to improve their mobility.             Speech therapy is also very important for a child with Cerebral Palsy who may be having problems.  Schools can help the student to improve their speech by having them see a speech and language pathologist twice a week or so.  The general education teacher can also work with the students to help them with motor skills, memory, or whatever other learning deficits that the students may have.             Cerebral Palsy is a disorder that can not be cured but it can be prevented.  This can be done by making sure that your child wears a helmet when they go to ride their bikes and gets regular checkups at the doctor.  This disorder affects many children and adults every year, and with more research may in time be able to be cured.  If your child does have Cerebral Palsy, just remember that help is out there.  You can get help at home and within your schools.

Reference:

Bachrach, M. Cerebral palsy A guide for care.  Retrieved Nov 08, 2004, from CEREBRAL PALSY PROGRAM Web site: http://gait.aidi.udel.edu/.

Blischak, M.D. (1995).  Thomas the writer: Case study of a child with severe physical, speech, and visual impairments.  Language, Speech, & Hearing Services in Schools, 26(1), 11-20.

Blundell,  W.S. (2003).  Functional strength training in cerebral palsy: A pilot study of a group circuit training class for children aged 4-8 years.  Clinical Rehabilitation, 17(1), 48-57.

Cerebral palsy: hope through research.  Retrieved Nov 08, 2004, from National Institute of Neurological Disorders And Stroke Web site: http://www.ninds.nih.gov.

DiMario, F. J. (2003).  Dissociation of motor maturation.  Journal of Child Neurology, 18(6), 391-393.  

Farmer, S. E. (2003).  Key factors in the development of lower limb co-ordination: implications for the acquisition of walking in children with cerebral palsy.  Disability & Rehabilitation: An International Multidisciplinary Journal, 25(14), 807-816.

Katz, R. T. (2003).  Life expectancy for children with cerebral palsy and mental retardation: Implications for life care planning.  NeuroRehabilitation, 18(3), 261-270.

Parks, J. (2002).  Use of physiotherapy and alternatives by children with cerebral palsy: A population study.  Child: Care, Health & Development, 28(6), 469-477.

Reis, S. M. (2002).  Underachievement in gifted and talented students with special needs.  Exceptionality, 10(2), 113-125.

Reading, R. (2002).  Cramped synchronized general movements in preterm infants as an early marker for cerebral palsy.  Child: Care, Health & Development, 28(5), 434-435.

Scholtes, V. (2002).  Measuring perceived competence and social acceptance in children with cerebral palsy.  European Journal of Special Needs Education, 17(1), 17-87.

Turnbull, R., Turnbull, A., Shank, M., & Smith, S. (2004). Exceptional lives special education in today's schools. 4th ed. Upper Saddle River, Nj: Pearson Prentice Hall.

Volkmann, C. S. (1978).  Integrating the physically disabled student into the elementary school.  Education, 99(1), 25-30.

UCP.  Retrieved Nov 08, 2004, from United Cerebral Palsy Web site: http://ucp.org/.