1. Joe Conte and Sarah Lupo
Cerebral Palsy
Joe Conte and Sarah Lupo 1

2. Video 2

3. What is Cerebral Palsy?
A group of permanent disabling symptoms resulting from damage to the motor control areas of the brain
A non-progressive condition that might originate before, during, or shortly after birth
Cerebral = brain
Palsy = disordered movement or posture 3

4. Statistics
According to the United Cerebral Palsy Association an estimated 500,000 have cerebral palsy.
10-20% of children with cerebral palsy acquire the disorder after birth.
The average lifetime cost for a person with cerebral palsy totals nearly $1 million
Cerebral palsy is diagnosed in approx. 8,000 children each year
Cerebral palsy is the most common cause of childhood physical disability, occurring in 2-3 out of 1000 children 4

5. Causes of Cerebral Palsy
Illness during pregnancy
Premature delivery
Insufficient amount/Lack of oxygen supply to the fetus/newborn infant’s brain
Lead poisoning
Illness early in the infant’s life
Child abuse
Medical negligence
Many times it is unknown 5

6. Symptoms of Cerebral Palsy
Developmental delay
Abnormal muscle tone
Unusual posture
Early development of hand preference 6

7. Classifications of Cerebral Palsy
Topographical
Neuromotor
Functional 7

8. Topographical Based on the body segments afflicted
Typically used by medical professionals
Classes include:
Monoplegia
Diplegia
Hemiplegia
Paraplegia
Triplegia
Quadriplegia 8

9. Neuromotor
Spasticity
Athetosis
Ataxia 9

10. Spasticity
Result from damage to motor areas of the cerebrum; characterized by increased muscle tone, primarily of flexors and internal rotators, which might lead to permanent contractures and bone deformities 10

11. Athetosis
A condition that occurs when there is damage to the basal ganglia (masses of gray matter composed of neurons located deep within the cerebral hemispheres of the brain) results in an overflow of motor impulses to the muscles.
Some characteristics of this type of CP include slow, writhing movements that are uncoordinated and involuntarily. 11

12. Ataxia
Condition that occurs when there is damage to the cerebellum (which normally regulates balance and muscle coordination).
Diagnosed when the child attempts to walk.
Muscles show abnormal degrees of hypotonicity.
Conditions
Individual shows lack of balance and coordination necessary for proper arm and leg movement causing a wide-based gait to be exhibited.
Individuals show difficulty with performing basic motor skills and pattern that include locomotor movements such as running, jumping, and skipping. 12

13. Functional
Individuals are placed into one of eight ability classes according to the severity of the disability.
Important system for physical education teachers because it categorizes the individuals according to their disability levels.
Teachers and coaches can use this classification system to help make the competition among the individuals equal (in competitive activities individuals who have the same classification can compete against each other. 13

14. Functional 14

15. Common Characteristics in the Psychomotor Domain
Seizures
Spastic or rigid muscles
Contractures may develop when restricted range of motion is severe
Hyperactive Stretch Reflex
Scissoring gate or hemiplegic gate
Persistence of unwanted primitive reflexes and tremors
Involuntary movement (e.g., constant, unpredictable, purposeless movement)
May exhibit both hypertonic and hypotonic muscle tone
Low postural tone; may be able to walk unaided, usually with arms held out to the sides
Often under or over reaches
Falls and stumbles easily 15

16. Common Characteristics in the Cognitive Domain
Loss of perceptual ability
Difficulty with speech
Learning disability or mental retardation 16

17. Common Characteristics in the Affective Domain
Difficulty socializing with their peers
May be withdrawn
ADHD 17

18. Teaching Styles Be very patient and use wait time
Reinforce language and speech
Add weights to implements, such as bats and racquets, to help with tremors or unwanted movements
Be careful with how you have them move 18

19. Exercising with Cerebral Palsy
Know the characteristics of each individual and their capabilities
Resistance training helps improve overall motor function and even flexibility
Isokinetic training
Cycle ergometers help with cardiorespiratory endurance 19

20. Diagnosis Test reflexes Check for hand preference
Rule out other disorders that can cause movement problems
Perform CT scan, MRI, and/or ultrasonography
Look for other conditions linked to cerebral palsy 20

21. How to Manage Cerebral Palsy
Management is directed at alleviating symptoms that are caused by damage to the brain and helping the child achieve maximum potential in growth and development. 21

22. Technology and Cerebral Palsy
Assistive technology
Computers
Communication boards with words or symbol systems
Bikes or scooters
Motorized wheelchairs 22

23. Treatment Team
People involved in the planning, treatment, and decision-making of an individual with cerebral palsy
Healthcare professionals who are involved with the individual
Family and other caregivers
Teachers who know the individual 23

24. Treatment and Therapy
Since cerebral palsy is so diverse the treatment of it can vary greatly from one individual to another.
There is no cure, but there are many therapies to help people better handle their condition
Physical therapy
Occupational therapy
Botox
Stem cells
The focus of treatment is on helping the individual reach his/her highest level of independence.
Individualized plans for treating C.P. should be centered around the needs of the individual. 24

25. Other interesting ways to treat cerebral palsy
Dolphin therapy:
Developed by American psychologist David E. Nathanson around 1978
Allows children with cerebral palsy to step into a different environment and interact with the dolphin in a way that is both playful as well as constructive for that child. 25

26. Dolphin Therapy (Continued)
Research has shown that dolphins who are one of the most intelligent animals are actually able to recognize the child’s deficiency which helps the child create a connection with the dolphin.
The connection has been known to help the child relax as well as an openness to learn and heal that can help lead to developmental progress. 26

27. Space Suit Therapy
Becoming increasingly popular for individuals with cerebral palsy.
The suit is also known as Therasuits or Therapy suits and it resembles an outfit that was originally developed by the Russians that helped their astronauts maintain their muscle tone while they were in space. 27

28. Space Suit Therapy (Continued)
The suit has elastic cords that attach to different areas of the body and they are positioned to keep the body properly aligned to forcibly encourage movement within a normal range of motion.
The design of the suit causes an individual with cerebral palsy to limit body movement in particular ways in order to force the body into proper physical alignments and help to replace awkward movements with more proper movements. 28

29. Benefits of Space Suit Therapy
Provides proper body alignment which helps improves muscle tone as well as body awareness, gross motor skills and balance.
Because the suit helps align and balance the body it also strengthens the body as well. 29

30. Incorporating Video Games
Though more research and studies need to be done, a recent study showed that using a Nintendo Wii for children with cerebral palsy help them improve in different areas including their visual perception, bodily control as well as their functional mobility.
If more research shows the same types of consistency, this could be a huge step for helping individuals with cerebral palsy because compared to other types of rehabilitation techniques the Wii is only a fraction of the cost and is commercially produced, which means the individuals could have it in their house and use it on a daily basis. 30

31. Could malpractice cause cerebral palsy?
If a mistake is made during the birth of an infant that was the cause of cerebral palsy doctors as well as nurses can be held accountable.
Many doctors and nurses do not know enough about cerebral palsy and this can result in devastating mistakes and lawsuits if a mistake is made.
While caring for the expectant mother and fetus, medical providers are responsible for assuring adequate care during the pregnancy, during labor and delivery, and immediately after the delivery of the infant. When injury does occur during the birthing process, the results can be devastating.
A cerebral palsy lawyer can help you determine if medical malpractice caused your child's cerebral palsy. 31

32. Malpractice That Can Result in Cerebral Palsy
Leaving the child in the birth canal too long
Failure to detect a prolapsed umbilical cord
Failure for the doctor to perform a cesarean section (c-section)
Failure to respond to the mother’s changing conditions
Failure to recognize and treat seizures 32

33. Something to Keep in Mind
In an Australian study, most medical students have a very limited knowledge of cerebral palsy
They also have negative attitudes toward individuals with cerebral palsy as a result 33

34. Legal Information and CT Laws
Cerebral Palsy Lawyers
Haymond Law
A lawsuit may be filed within 2 years from the date of the injury
An expert witness must be present
Must be a doctor who has been licensed and practicing for 5 years
Compensation
There is no limit on the amount of damage award
Limit for Attorney Fees
No more than 1/3 of the first $300,000
25% of the next $300,000
20% of the next $300,000
15% of the next $300,000
10% of an award greater than $1.2 million 34

35. Examples of Lawsuits Cody - Aurora, Illinois – 2001-2002
Mother filed suit against the doctors and hospital because her son was born with brain damage and cerebral palsy
The doctor failed to successfully use the vacuum extractor device, which was needed to prevent brain injuries during the delivery
The doctors performed an emergency C-section when they realized that the baby’s heart rate was in distress
She received $15.35 million for her son’s past and future medical expenses 35

36. Examples of Lawsuits Hannah - Tennessee
The doctors used the wrong instruments when delivering Hannah
The nurse and surgical technician failed to follow instructions of the doctor
Two doctors at the hospital were in a relationship, which affected morale
As a result, Hannah has cerebral palsy
Severe brain damage, seizures, developmental delays
At age 8, Hannah cannot speak and feels pain when people walk past her 36

37. Devastating Costs of Cerebral Palsy
According to an “…estimated lifetime expense of living with cerebral palsy is approximately $921,000 a person.” 37

38. Common Medical Expenses
Doctor visits
Hospitals
Visits to the E.R.
Various types of medications
Surgeries
Rehabilitation
Psychological counseling
Assistive devices 38

39. Common Non-Medical Expenses
In order for individuals with cerebral palsy to live their lives they need special arrangements that include:
Home modifications
Vehicle modifications
Special education programs
Other modified living arrangements to allow mobility 39

40. Indirect Costs
According to “…indirect costs are considered the limitations a person suffering from cerebral palsy has and the effect on their overall life.”
Some of these costs include:
Loss of wage
The loss of earning potential
The inability to provide for or contribute to their life financially, due to severely debilitating conditions
Pain and suffering 40

41. References
Cerebral Palsy & Technology. (n.d.). Retrieved March 10, 2009, from
Cerebral Brainpalsy.com. (n.d.). Retrieved March 14, 2009, from
Dolphin Therapy In Kemer Antalya - Turkey - Video. (n.d.). Retrieved March 30, 2009, from
ExpertHub Inc.. (n.d.). Medical Malpractice Law in Connecticut. Retrieved March 18, 2009, from
French, R. (n.d.). Cerebral Palsy: APE Fact Sheet. Retrieved March 10, 2009, from
MacLennan, A., Nelson, K., Hankins, G., & Speer, M. (2005). Who Will Deliver Our Grandchildren?: Implications of Cerebral Palsy Litigation. Journal of the American Medical Association, 294(13), Retrieved March 30, 2009, from the Academic Search Premier database.
Martin, H., Rowell, M., Reid, S., Marks, M., & Reddihough, D. (2005). Cerebral Palsy: What Do Medical Students Know and Believe?. Journal of Paediatrics & Child Health, 41(1/2), Retrieved March 17, 2009, from the Academic Search Premier database.
Infocus Studios, LLC.. (n.d.). Cerebral Palsy & Medical Malpractice Claims. Retrieved March 17, 2009, from
Rimmer, Ph.D., J. H. (n.d.). Introduction to Cerebral Palsy and Exercise. Retrieved March 18, 2009, from
Winnick, J. P. (2005). Adapted Physical Education and Sport 4th ed.. Champaign, IL: Human Kinetics.
eJustice.com. (n.d.). Cerebral Palsy Source. Retrieved March 8, 2009, from