1. 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

2. 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

3. 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

4. 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.

5. 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 % 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

6. 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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. * 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Bibliography
National Institute of Neurological Disorders and Stroke -
United Cerebral Palsy -
Public Medical Health
Assistive Technology to Meet K–12 Student Needs -

20. 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?
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