Including Students with Cerebral Palsy in the Primary Classroom Shannon Rust-Dickey Shannon Rust-Dickey EDSP 6644 Fall, 2005

Effects of Cerebral Palsy Main features of Cerebral Palsy (CP) Main features of Cerebral Palsy (CP) CP is a condition caused by damage to the brain, usually occurring before, during, or shortly after birth. CP is a condition caused by damage to the brain, usually occurring before, during, or shortly after birth. “Cerebral” refers to the brain and “Palsy” to a disorder of movement or posture. A lack of muscle control (Council for Exceptional Children). “Cerebral” refers to the brain and “Palsy” to a disorder of movement or posture. A lack of muscle control (Council for Exceptional Children). Non progressive Non progressive There is not a cure for CP, but advances in medicine and rehabilitation technology offer hope for people who have CP. There is not a cure for CP, but advances in medicine and rehabilitation technology offer hope for people who have CP. Four main types of CP Spastic: Stiff and difficult movement % of people who have CP have this type (CDC) Athetoid or dyskinetic: Involuntary movement of muscles Ataxic:Disturbed sense of balance of depth perception Mixed: Combination of more than one type

Effects of CP, (cont.) Contradicting Definitions Contradicting Definitions Hallahan & Kauffman (2006) were one of the few sources I found who consider CP to be more than motor impairment. They say CP can be considered part of a syndrome that includes motor dysfunction, psychological dysfunction, seizures, and emotional or behavioral disorders due to brain damage. Hallahan & Kauffman (2006) were one of the few sources I found who consider CP to be more than motor impairment. They say CP can be considered part of a syndrome that includes motor dysfunction, psychological dysfunction, seizures, and emotional or behavioral disorders due to brain damage. Other sources would say that people with CP are often affected by other disorders which account for other challenges than motor impairment (National Institute of Neurological Disorders and Stroke). Other sources would say that people with CP are often affected by other disorders which account for other challenges than motor impairment (National Institute of Neurological Disorders and Stroke). For the purposes of this presentation, I am going with the majority and focusing on CP as being primarily a lack of motor impairment and muscle control. For the purposes of this presentation, I am going with the majority and focusing on CP as being primarily a lack of motor impairment and muscle control. These features differ from other disabilities People with CP have great challenges with motor impairment. They may have average intelligence but have troubles seeing or hearing (Courbois, Coello, & Bouchart). This is different from other disabilities since most other disabilities have more difficulties with psychological dysfunctions.

Modifying the Learning Environment Accommodations Accommodations Allowing students to take tests orally or allow students to take tests in writing and then have them orally explain their answers. Allowing students to take tests orally or allow students to take tests in writing and then have them orally explain their answers. Have a scribe for the student Have a scribe for the student Math manipulatives Math manipulatives Allow extra time to complete assignments Allow extra time to complete assignments Adaptive typewriters, pencil holders, page turners, book holders Adaptive typewriters, pencil holders, page turners, book holders Voice-output augmentative communication technology (if needed) Voice-output augmentative communication technology (if needed) Cards to use in place of speech Cards to use in place of speech Provide bigger spaces on worksheets to write answers Provide bigger spaces on worksheets to write answers Modifications (In PE) Having a student with CP walk with their walker (if appropriate for that child) from one side of the field to the other instead of having them run 2 laps with the rest of the class.

Modifying the Learning Environment, (cont.)  The physical environment of the classroom  Must have room for a walker and or wheelchair to access places (centers would be an example in a primary classroom)  Need space to store the walker and wheelchair when not in use.  Place for a special desk and chair if student uses one. Students with CP would most likely require more accommodations than modifications when it comes to school. Students with CP can usually achieve the same goals as others students in the general curriculum. They may just need a small change in order to do so.

Developmental Considerations Language, Sight, and/or Hearing Disorders Language, Sight, and/or Hearing Disorders Some people with CP have difficulties speaking and some cannot speak at all. Others may have difficulties seeing or hearing, too! Some people with CP have difficulties speaking and some cannot speak at all. Others may have difficulties seeing or hearing, too! Social-emotional development Social-emotional development Students with CP may have a difficult time fitting in with peers. They may feel depressed about certain physical incapability's - especially if no other disabilities are present and their intelligence is normal to above normal (British Columbia Dept. of Education). Students with CP may have a difficult time fitting in with peers. They may feel depressed about certain physical incapability's - especially if no other disabilities are present and their intelligence is normal to above normal (British Columbia Dept. of Education). Other motor impairments Other motor impairments Students may be wheelchair bound Students may be wheelchair bound Students may use a walker Students may use a walker Students may crawl around the classroom Students may crawl around the classroom

Developmental Considerations, (cont.) How developmental factors influence teaching How developmental factors influence teaching The arrangement of the classroom (wheelchair and/or walker accessible) The arrangement of the classroom (wheelchair and/or walker accessible) Scheduling (be careful not to schedule tests when the student is at therapy) and you will also probably have to schedule bathroom times as many students with CP need assistance in the restroom. Scheduling (be careful not to schedule tests when the student is at therapy) and you will also probably have to schedule bathroom times as many students with CP need assistance in the restroom. For special activities outside of the classroom or school (field trips), make sure appropriate arrangements have been made so the student can participate (British Columbia Dept. of Education). For special activities outside of the classroom or school (field trips), make sure appropriate arrangements have been made so the student can participate (British Columbia Dept. of Education). Work with other professionals as a team to help the student. Many students with CP will see one or all of the following: Work with other professionals as a team to help the student. Many students with CP will see one or all of the following: Speech Therapist, Occupational Therapist, Physical Therapist, Special Education Teachers, Para Professional, Counselors. Speech Therapist, Occupational Therapist, Physical Therapist, Special Education Teachers, Para Professional, Counselors.

Monitor Student Progress CP can impact learning since students need the use of their hands to learn to write, read, manipulate objects, draw, and color. CP can impact learning since students need the use of their hands to learn to write, read, manipulate objects, draw, and color. To help students with these challenges, we can provide appropriate accommodations and help them learn how to function with their difficulties. To help students with these challenges, we can provide appropriate accommodations and help them learn how to function with their difficulties. Provide magnetic letters during writing time Provide magnetic letters during writing time Provide computer time (if available at your school) since computers can facilitate literacy learning in students with CP (Dennis, 1995) Provide computer time (if available at your school) since computers can facilitate literacy learning in students with CP (Dennis, 1995) Provide bigger manipulatives during math Provide bigger manipulatives during math Students also need the use of their voices during school. If they cannot speak, we have to find other ways for them to communicate with us and show us what they know. We might think they don’t know things, especially in the area of reading, when in actuality they just cannot let us know. Students also need the use of their voices during school. If they cannot speak, we have to find other ways for them to communicate with us and show us what they know. We might think they don’t know things, especially in the area of reading, when in actuality they just cannot let us know. To help students with this challenge, we can try to advocate to get them appropriate technology to assist them with speaking. To help students with this challenge, we can try to advocate to get them appropriate technology to assist them with speaking. Voice-output augmentative communication technology has been found to lead to improved communication skills as well as increased demonstratiosn of literacy capabilites (Erickson & Koppenhaver, 1997). Voice-output augmentative communication technology has been found to lead to improved communication skills as well as increased demonstratiosn of literacy capabilites (Erickson & Koppenhaver, 1997).

Monitor Student Progress, (cont.)  According to Hallahan and Kauffman (2006), the educational problems of children who have CP can be multifaceted.  These students need accommodations and assistance with most activities in the general education classroom.  Para educators are often necessary for students with CP. Some students may require a full-time Para educator while others may simply need assistance with a few things (British Columbia Dept. of Education).  Students with CP, even if they have average intelligence, often need more assistance than students with other disabilities due to the great amount of motor impairment.

Differentiating Instruction – Classroom Strategies Examples of differentiating instruction for students with CP Examples of differentiating instruction for students with CP Providing a pattern when working on an art project instead of having them get frustrated with free hand. Providing a pattern when working on an art project instead of having them get frustrated with free hand. In math, allow the student to show they can add and subtract using manipulates instead of writing. In math, allow the student to show they can add and subtract using manipulates instead of writing. If note-taking is required, provide the notes for the student. If note-taking is required, provide the notes for the student. Work with small groups Work with small groups Allow students to work in groups Allow students to work in groups Accept work that may not be legible and then later have the student explain what they wrote (Awareness of Chronic Health Conditions) Accept work that may not be legible and then later have the student explain what they wrote (Awareness of Chronic Health Conditions) Since CP is primarily a disability of motor dysfunction, differentiating instruction for academics should not be necessary unless the student also has another disability. Since CP is primarily a disability of motor dysfunction, differentiating instruction for academics should not be necessary unless the student also has another disability.

Choosing and Implementing Strategies and Interventions There are several strategies to assist students with CP. General educators can use all of them in the classroom. There are several strategies to assist students with CP. General educators can use all of them in the classroom. For students with reading, writing, and/or math difficulties For students with reading, writing, and/or math difficulties Similar to what you would do with general education peers Similar to what you would do with general education peers Text-rich environment, read aloud to students, provide individual or small group instruction with just what the child needs (Dennis, 1995). Text-rich environment, read aloud to students, provide individual or small group instruction with just what the child needs (Dennis, 1995). Provide extra assistance, tutoring, monitor progress very closely, differentiate instruction, assessment needs to drive instruction Provide extra assistance, tutoring, monitor progress very closely, differentiate instruction, assessment needs to drive instruction  For these interventions to work, we must ensure students are receiving appropriate accommodations for their motor impairments.

Using the IEP to Plan Instruction Goals for students who have CP Goals for students who have CP Toileting alone Toileting alone Dress themselves Dress themselves Write legibly Write legibly Use scissors and pencils Use scissors and pencils Learn to use assistive technology Learn to use assistive technology Learn to manipulate and use a walker appropriately Learn to manipulate and use a walker appropriately Transfer in and out of wheelchair alone Transfer in and out of wheelchair alone Learn to read and do math at the same rate as general education peers (if no other disability is present) Learn to read and do math at the same rate as general education peers (if no other disability is present) Role of the general educator in reaching these goals Be a part of the IEP team and be familiar with goals and objectives Consistently provide needed accommodations as stated in the IEP General educators should focus on the academic goals on the IEP. They should help students with CP learn to read, write, and do math at an appropriate level for their abilities – just like general educators do for all other students. They can also help students learn to use scissors and pencils and write legibly (if they have the ability to learn).

References British Columbia Department of Education. Special Education Branch, Ministry of Education. (1995). Awareness of Chronic Health Conditions: What the Teacher Needs to Know. Center For Disease Control: National Center on Birth Defects and Developmental Disabilities. Cerebral Palsy. Retrieved on November 25, Coubois, Y., Coello, Y., & Bouchart, I. (2004). Mental Imagery abilities in adolescents with spastic diplegic cerebral palsy. Journal of Intellectual & Developmental Disability, Vol. 29, 3, Council for Exceptional Children: Information Center on Disabilities and Gifted Education. (2000). Retrieved on November 25, Dennis, M. (1995). Literacy and cerebral palsy: Factors influencing literacy learning in a self- contained classroom. Journal of Reading Behavior, Vol. 27, 4, Erickson, K. & Koppenhaver, D. (1997). Integrated communication and literacy instruction for a child with multiple disabilities. Focus on Autism & Other Developmental Disabilities, Vol. 12, 3, Hallahan, D. P. & Kauffman, J. M.(2006). Exceptional learners: Introduction to special education, 10th Ed. San Francisco: Allyn and Bacon. National Institute of Neurological Disorders and Stroke. Cerebral Palsy Information Page. Retrieved on November 25,