Cerebral Palsy A condition that is caused by the failure of the brain to develop properly or neurological damage to the child’s brain. It affects motor skills, movement and muscle tone. Leia, Tracy and Mary

How Common is CP More than 500,00 people in the United States have CP CP occurs in approximately 2 per 1,000 live births Every year almost 8,00 infants and 1,500 preschool children are diagnosed with the condition This frequency rate hasn’t changed in more than four decades, even with the significant advances in the medical care of newborns Higher in males than females

Etiology *Usually occurs during fetal development or infancy, but can also occur after infancy Exposure to radiation Infection Asphyxia before birth Hypoxia of the brain Birth trauma during labor and delivery Drowning Severe Jaundice Lead Poisoning Physical brain injury Shaken baby syndrome Meningitis * Between 40-50% of children with CP were born prematurely

Identifying Factors: Lethargy/lack of alertness Irritibility/fussiness Abnormal/high-pitched cry Trembling of the arms/legs Poor feeding abilities secondary to sucking& Swallowing Low muscle tone Abnormal Reflexes Seizures Child holds his/her hand in tight fists Asymetries of movement-one side of the body may move more easily than the other Tongue pushing food out of mouth when eating *Some doctors hesitate to diagnose CP right away.

Types of Cerebral Palsy *CP is often classified by the type of motor dysfunction Spasticity: the most common type of dysfunction. Involves a mild to severe exaggerated contraction of muscles when the muscle is stretched. It can involve the entire body or only parts of the body. 70-80% of all cases fall under this category. *Hemiplegia-one side of body affected, limp *Diplegia-lower extremities affected with little to no upper body spasticity (70-80% of known cases) *Monoplegia-One single limb affected *Triplegia- Three limbs affected *Quadriplegia-Four Limbs affected. Some have tremors and uncontrollable shaking

Dyskenesia/Athetoid: characterized by involuntary extraneous motor activity, especially under stress. It is caused by injury to the basal ganglia, the brain’s motor switchboard. Occurs in 10-20% of all cases. Ataxia: Occurs when an injury has occurred in the cerebellum. The child has a lurching walking gait. Occurs in 5-10% of all cases. *Abnormal sensation/perception, impairment of sight, hearing or speech, seizures * A child can have more than one type of CP

Some health issues: Bone thinning or osteoporosis Delayed growth and development Poor sight, hearing and speech Hip problems Higher incidence of being injured when falling, Osteopenia Joint contractures Incontinence Abnormal perception of sensations Poor nutrition In some patients, reduced communication skills Scoliosis and other spinal deformities Seizures, though this only occurs in about half of patients Epilepsy

These health problems can lead to: Depression Premature aging Arthritis Post-impairment syndrome Other medical conditions

Treatment *Treatment is based on the person’s symptoms and the need to prevent complications There is no cure for Cerebral Palsy. The goal of treatment is to help the person be as independent as possible Treatment requires a team approach: Primary care doctor Social Worker Nurses Occupational, physical and speech therapists Other specialists include: Neurologists, rehabilitation physician, pulmonologist and gastroenterologist, Mental Health Practitioner, orthopetic surgeon

Medical interventions such as braces, surgery and prescribed therapies can help Physical and Occupational therapies: exercise, strengthen and position muscles, bones and joints Prevention of serious and painful contractures, dislocations, and rigidity is critical for individuals with CP Physical and Occupational therapies facilitate the development of normal reflexes and maximize the control a person can have over their environment

Medications Anticonvulsants to prevent or reduce the frequency of seizures Botulinum toxin to help with spasticity and drooling Muscle relaxants (Baclofen) to reduce tremors and spasticity Diazepam (muscle relaxant) Dantrolene sodium (Dantrium) Surgery is needed in some cases to: Control of gastroesophageal reflux Cut certain nerves from the spinal cord to help with pain and spasticity Place feeding tubes Release joint contracture Eye surgery for cataracts

Self and Home Care include: Getting enough food and nutrition Keeping the home safe Performing exercises recommended by the health care providers Practicing proper bowel care (stool softeners, fluids, fiber or laxatives) Protecting the joints from injury

* Putting child in regular schools is recommended The following may help with communication and learning: Glasses Hearing aids Muscles and bone braces Walking Aids Wheelchairs

Assistive Technology for Access: Adapted handles (e.g. pencil grips) Adapted Book-page turners or fluffers Book holders Built-up stylus/Joysticks/Adapted mouse A mouth stick to press keys on the keyboard Foot pedals or hardware switches instead of a mouse to operate a technology device Arm support Slant board/Tilt board Voice input or output devices Voice recognition software Computer-access modification software (touch window, portable word processor, word-completion utilities, Keyboards with accessibility options to input or encode text

If you have a child with CP in your classroom you should: should set up the classroom so that plenty of space is available for the student to move around the room and to sit comfortably at a desk. Items that may interfere with the safety of a child with CP should be placed out of reach. In the classroom, use of a tape recorder or a “note buddy” for writing notes are simple accommodations that teachers commonly arrange. Students who struggle with communication should have the option of using assistive technological equipment in the classroom

Impact on Language Development Speech Problems are commonly associated with poor respiratory control, laryngeal (monopitch,low, weak and breathy voice quality), velopharyngeal and articulatory dysfunction. Dysarthria- a condition that occurs when problems with the muscles that help you talk make it difficult to pronounce words. Affects 31-88% of people with CP. *Soft palate (roof of mouth) can affect speech *Ataxic CP has erratic speech patterns due to diminished ability to control facial muscles *Dyskinetic CP-difficulty controlling body movements due to differences in muscle tone, so they have difficulties controlling their vocal cords and tongue=slurred speech *Spastic Quadriplegia-have difficulties swallowing and have limited motor control, muscles of the tongues and mouth are affected. Harder to understand speech

Impact on Social Skills: Some children with CP are put into mainstream classes and are able to socialize with children without disabilities Child can be confronted by barriers that hurt their socialization. -micro, meso and macro barrier levels: Micro: Child’s physical limitations. Ex) Child may not be able to participate because of lack of confidence or because they are in a wheelchair Meso: Family and Community. Negative attitudes of people towards disabilities or lack of support within the family/community Macro: Systems and policies that are not in place or hurt children with CP. Include architectural barriers, lack of assistive technology and lack of transportation aid Ex) building without an elevator

Behavior Issues Parent-reported behavior problems were 5 times more likely in children with CP (25.5%) compared with children having no known health problems (5.4%) Frustration is one of the most common problems found in children Attention Deficit Disorder Some let their attention wander and become distracted

Bibliography National Institute of Neurological Disorders and Stroke - www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm United Cerebral Palsy - www.ucp.org Public Medical Health http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734/#adam_000716.disease.support-groups Assistive Technology to Meet K–12 Student Needs http://www.ncrel.org/sdrs/areas/issues/methods/technlgy/te7assist.htm http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734 http://health.nih.gov/topic/CerebralPalsy http://www.ucp.org/www.cerebralpalsysource.com/About_CP/behavioral.../index.html - http://jpepsy.oxfordjournals.org/content/21/3/447.abstract http://www.essortment.com/cerebral-palsys-effects-speech-26843.html

Discussion Imagine you are a person who has Cerebral Palsy on Wheelock’s campus. Discuss some disadvantages you’d run into. What would it be like to get to class, the cafeteria, or the Brookline campus? What are some advantages that Wheelock’s campus has over a campus such as Northeastern or Boston University? http://www.youtube.com/watch?v=kr5hHmZbQHw &feature=youtube_gdata_player