Cerebral+Palsy


 * __Cerebral Palsy__**



Cerebral Palsy or CP is not a disease. “Cerebral” refers to the brain and “Palsy” refers to weak or poor muscles. CP is a permanent brain injury, which occurs before, during, or shortly after birth, and affects body movement and muscle coordination. CP is mainly characterized by an inability to fully control the motor function of the body, which may include tight muscles or spasms, involuntary movement, and/or disturbance in the way the person walks. It is not communicable, and is not progressive and the majority of people who have CP are born with it. Lack of oxygen, illness, poisoning, and head injury are some factors that can cause cerebral palsy. The diagnosis of CP is difficult at birth but is usually diagnosed within the first 24 months of a child’s life. The effects of CP vary widely from individual to individual. At its mildest, CP may result in a slight awkwardness of movement or hand control. At its most severe, CP may result in virtually no muscle control, profoundly affecting movement and speech.
 * __Definition:__**

Depending on which areas of the brain have been damaged, one or more of the following may occur: - muscle tightness or spasm - involuntary movement - difficulty with gross motor skills such as walking or running - difficulty with fine motor skills such as writing and speaking - abnormal perception and sensation Therefore, every person who has CP is unique. CP describes many different types of disability, ranging from mild to severe, with different causes, affecting individuals in many ways.

__**Characteristics**__ Characteristics depends on which side of the brain is damaged. Some major ones are: - Lack of muscle control and movement - Seizures - Visual and hearing problems - Learning disorders - Increased salivating » Can be fixed with surgery, or drugs can reduce the amount of saliva - Walking with one foot/leg dragging - Eating problems » Because muscles in the face are affected may have trouble eating or develop malnutrition - Intercontinence (poor bladder control)



There are three types of cerebral palsy. These are: **1) Spastic CP 2) Ataxic CP 3) Athetoid CP**



//1) Spastic CP// - This form is the most common. - Individuals have stiff permanently contracted muscles - They do jerky or exaggerated movements - Within spastic there are 5 subcategories: a) Diplegia (both arms of both legs are affected) b) Hemiplegia (one side of body is affected, either right leg/arm, or left leg/arm) c) Quadriplegia (all arms and legs affected) d) Monoplegia (only one arm or leg affected) e) Triplegia (3 arms or legs are affected)



//2) Ataxic CP// - Lack of muscle coordination with voluntary movement - Less common - Affects depth perception and balance » They have a poor gait when walking - They have 'Intention Tremors' » This is a tremor which starts when doing a voluntary movement, like reaching for an object, and becomes more severe as you move closer to the object.

//3) Athetoid CP or Dyskinetic CP// - Slow uncontrolled movements - Affects arms, legs, hands, and feet - This type rarely affects musculature of face and tongue, which leads to drooling and grimacing - When going through stressful or emotional times, the affects worsen during this time - The affects may disappear entirely during sleep - People with this type may have problems coordinating muscles for speech. And this can lead to dysarthia (when speech is slowed and slurred), or hypernasal (too much air flow through nose), or hyponasal (not enough air flow through nose)


 * An individual may have mixed forms, the most common mixture is spastic and athetoid.

It is difficult to estimate exactly how many people have CP. Many people with mild CP are never diagnosed, while others may have multiple disabilities which overshadow their CP. It is estimated that one out of every 500 babies, and up to one in 3 premature babies are affected to some extent. There are over 50 000 Canadians with CP.
 * __Incidence:__**

- 70% of CP patients have spastic CP - 10-20% have athetoid CP - 5-10% have ataxic CP

__**Assessment**:__ Assessing CP at birth is very difficult and therefore is usually diagnosed after the child has developed several months and mild cases of CP may only be diagnosed after 2 years old. The first two indicators of CP are abnormal muscle tone, and favouring one side of the body over the other. Abnormal muscle tone may be hypotonia (decreased muscle tone) or hypertonia (increased muscle tone).

Diagnosis is based on the doctor’s observation of: - motor skills - mother and child’s health history - child’s reflexes - child’s hand preferences - excessive vomiting as a child - gagging and feeding problems - drawing in of limbs or difficulty in straitening limbs - infant may writhe involuntary in an irregular motion

Since CP may be difficult to detect if it is not severe, doctors recommend merely observing the child through its developmental milestones and delay in these could assist the diagnosis. Physical milestones to observe * Brings hands together - 4 months
 * Sits with out support - 6 months
 * Crawls - 9 months
 * Feeds self with fingers - 9 months
 * Hold bottle without a assistance - 12 months
 * Walks unassisted - between 12-15 months
 * Walks up and down stairs - 24 months

The Moro Reflex is the only instinctive fear that humans are born with. It is the fear of falling. If a baby drops back even a few inches into its mothers hand, the arms and feet will usually jolt in a frightened way. Loud noises also activate the moro reflex. The moro reflex is one test that doctors can use to test for any disorders in a babies motor system.

CAT scans (Computerized Axial Tomography) and MRI (Magnetic Resonance Imaging), can identify lesions in the brain. This technology enables some children who are considered at risk of having CP to be diagnosed very early. However, for the majority of people with CP it will be months, and sometimes years, before a diagnosis is confirmed.
 * __Diagnosis of CP:__**

Cerebral Palsy occurs from abnormalities in parts of the brain which controls muscle movement. Congenital CP (cerebral palsy) is when brain injury takes place during intra-uterine life and the birthing process. The cause of this is unknown. Cerebral Palsy is a result of brain damage, and there are many factors which can cause this. These are: • Accidents • Infection during pregnancy » Some examples are rubella, cytomegalovirus, and taxoplasmosis. These infections cause serious damage to the nervous system of the fetus. • Severe jaundice • Rh incompatibility (different blood types) » When this happens it can cause juandice, and the mother's immune system attacks the fetus. • Oxygen shortage • Stroke » A fetus can have a stroke if the mother suffers from coagulation disorders. • Toxicity » If a mother consumes too much drugs and alcohol during pregnancy. • Bleeding in the brain after the infant is born • Kidney/Urinary tract infections
 * __Causes of Cerebral Palsy__**

The occurance of CP is dependent on the mother's and child's health history. There is no cure for CP, however, there are treatments that can be used to improve an individual's capabilities and quality of life. There are some preventative measures that can be taken to lessen the chances of having a child with cerebral palsy. These are: • During pregnancy have regular testing of Rh factor. If the Rh factor is negative they can immunize the infant 72 hours after birth. • If a baby has severe jaundice they can place him/her under phototherapy (light therapy) in the hospital nursery. • Immunization against measles during pregnancy. • While pregnant reduce the exposure to viruses and other infections, x-rays, drugs, and medications. • Treatment of bacterial infections in mother's urinary tract. • Have control of diabetes, anemia, and nutritional deficiencies. • Most important preventative measures that anyone can take is to be __healthy prior to conception__, __good prenatal care__, and __protection of infants from accidents or injury__.

__**Strategies of Cerebral Palsy**__ Once a teacher has become aware that he/she will have a child in their classroom with CP, the first action they should take is to educate themselves and the other students about cerebral palsy. It is so important to understand the child's disability and the severity. Teachers must also become knowledgable of possible complications and the parents' views and thoughts. With CP, the teacher (s) and students have to recognize when/if the child is having a seizure, and know the proper actions to take when this happens.

When physically setting up the classroom make it so it is accomodating and safe for all students, but especially for the child with CP. You may need to have some braces installed, or maneuver the desks a certain way if a wheelchair is used. When deciding on seating arrangements, place the student in a small group that you know will be supportive and help along the way. Having the class in small groups improves communication skills, promotes social interaction and encouragement. And this does not only apply to kids with special needs. Furthermore, kids with CP may have severe hearing and visual disbilities, if this is the case in your class then have them sit near the front. When conducting lessons use good volume and make sure the student can see your face, especially if their hearing is not the best. Or have a video/tape recorder set-up so they can listen and view the lecture again. It is a good strategy to find out the student's best way to communicate and utilize it in your class as much as possible. This will make the student feel supported and apart of the class. Lastly, be aware of involuntary movements. Kids with CP tend to do jerking movements, if this occurs it is not that they turned their head away and were not listening, it is that sometimes they have little control of their body.

Consistently talk to the parents and support staff, they know and want what is best for the child. Give positive feedback to the parents, they will greatly appreciate this. When planning an IEP (Individual Education Plan), develop realistic goals and focus on the child's progress and positive change with their current abilities, and do not try and lessen their disability. Evaluate them on their strengths. If the student has a hard time writing, give them an oral exam.

Just like any other student, kids with CP __need__ to have fun and play with their peers. Have activities that enable the student to particpate. Allow them to voice their opinion and give them choices. Above all, be patient, kind, and understanding. These kids deserve a full and happy life, and have the right to learn and be successful.

The years of medical studies have shown that CP an extremely high trend of CP is with babies born premature. Those who weigh less than 1500g's at birth are at high risk of having CP. There is no increase or decrease in the occurance of CP in babies of normal birth weight.
 * __Trends with Cerebral Palsy__**

The impact on the development of learning with students that have CP will vary with the CP's level of sevarity. Many can live a successful and happy life just like Josh Blue, a well known comedian who has CP. In most cases of CP, the individual is usually only affected in motor skills ability, but as the level of sevarity increases the person may have some loss of hearing, bad eyesite, and speech problems. The speech problem may be the result of the motor ability in controling the mouth muscles or it may be a result of the childs loss of hearing, thus affecting the speech. In the highest level of CP the individual also suffers with cognitive thinking abilities. Each case of CP may be slightly different and therefore students may learn and develop easier than others who have CP. For the most part teachers do not need to make drastic instructional changes to their methods of teaching, nor do they have to make changes in the curriculum standards. With the possibility of speech and hearing impairment, communication may be more difficult, therefore adaptations may have to be made for student to be able to hear the teacher. The teacher may have to speak with a mike and headset for the student, or place the student close to the front of the class so that they will be able to hear. Because of the lack of control of the motor skills the student will most likely not be able to write quickly and therefore would merely need more time to complete tasks that involve hand written answers. CP students can usually progress through school without major impacts on their level of development and learning. CP students just need to be given time to do their work and encouragement to let them know that they are fully capable of competing at the highest levels of education.
 * __Impact on the Development of Learning__**

__**Issues with Cerebral Palsy**__ Researchers today are trying to find ways to prevent CP, reduce effects, and improve quality of life. There are questions being asked like: Can brain cells be re-grown to repair damage? What are the effects of aging for a person with CP? What are the social and emotional effects for kids with CP? One of these questions have been addressed, which is the effects of aging. It has been suggested that the physical challenges with CP increase as an individual gets older. This will lead to an increase in stress and anxiety. As well, adults with CP lose some of their mobility they gained when they were a child. Some reasons for this may be weight gain, no regular therapy or exercise, or other conditions arise, ie. arthritis.

The biggest development in CP today is the injection of 'botulinum toxin' (botox) into spastic muscles. This will reduce tone for several months. Currently, it is being questioned in USA because three children with CP died while on this medication. All three children had breathing complications, however, all three had a history of breathing difficulties before using botox injections. At this point the medication is not being recalled, and it is not being discontinued. When using this method you should be aware of the signs and symptoms of botulism: - difficulty in swallowing, breathing, and speaking - weakness These symptoms can occur after one day of use, or several weeks. If symptoms do arise, it is wise to see a doctor immediately.

Other directions that researchers are moving towards is early detection and diagnosis of CP using neuroimaging. Also being studied is early brain development and the damages that occur during this time. It has been suggested that genetic defects may be a contributing factor to brain damage. Lastly, researchers are exploring bleeding, epileptic seizures, and breathing and circulation problems which may happen in newborn brains. These events can cause an abnormal release of chemicals that can cause damage, and thus causing CP.

CP is not considered to be a curable condition and the word "management" is used more often than "treatment". However, there is much that can be done to lessen the effects of CP and help people with CP live indepedent lives.
 * __Treatment and Management of CP__**:

//__Therapy:__// - //Physical Therapy// » Aims to help people achieve their potential for physical independence and mobility. It includes exercises, correct positioning, and teaching alternate ways of movement such as walkers, bracing or handling a wheelchair. This therapy prevents deterioation of muscle tissue from the lack of use. It also helps avoid contraction in the muscles. - //Occupational Therapy// » Designs purposeful acitivities to increase independence through fine motor skills. It helps children to use adaptive equipment such as feeding, seating and bathroom aids. - //Speech Therapy// » Aims at improving communication. A child may only need help to overcome a slight articulation problem, or may not be able to communicate verbally and may require a non-verbal system. They include eye-gaze systems, blissymbol boards, and electronic voice synthesizers. - //Behavioral Therapy// » This therapy focuses on the improvement of physical, mental, and communicative skills. The use of this therapy varies depending on the individual's needs, age, and the severity of their CP. The professionals may discourage destructive behavior, or emphasize self-sufficiency. - //Drug Therapy// » Medication is used to control seizures and spasticity. Also to relax muscle spasms and lessen pain. Different drugs are used, and how much is prescribed depends on the indidvidual.

//__Surgery:__// - Surgical procedures occur to correct body abnormalities, release tight muscles, and lengthen tendons to improve mobility. When a child has finished growing, bone surgery may occur to reposition and stabilize bones. Surgery also reduces damaging effects of spasticity on the spine, hips, and legs.

__//Adaptive equipment://__ - Mobility devices (ie. wheelchairs, braces, walkers, crutches) are used to improve motor skills, and communicative devices (ie. voice synthesizers, symbol boards) are utilized to improve communication.

Many children with CP will have also some type of learning disability. Assessment by a psychologist, and the support of special educators can reduce the handicapping effects of a learning disability.Most children with CP will receive an I.E.P enabling them to mix with their peers in their neighborhood school. A child with more severe disabilities may require considerable support form resource staff and teaching assistants. I.E.P which assess the child's performances, sets goals and specifies which supports are required are ideal. The amount of support offered, and the commitment to successful intergration, varies widely between school boards and individual schools. A good partnership between parents and educators will help children to achieve their goals.
 * __Educational Supports:__**

Some Manitoba agencies/organizations that can provide support: - //Manitoba Education, Training and Youth. Special Education Support Unit// Marilyn Taylor (945-7921)
 * __Supports:__**

- //Manitoba Family Services and Housing Programs// [|Http://www.gov.mb.ca/fs/programs]

- //Society for Manitobans with Disbilities// 825 Sherbrook St (975-3010)

- //Manitoba Child Care Association// (586-8587)

- //The Cerebral Palsy Association of Manitoba Inc// 105-500 Portage Ave (982-4842)

- //Child Care Advocacy Association of Canada// Manitoba director, Debra Mayer (489-6897)




 * __Resources Used__**

- http://www.hemihelp.org.uk/files/inclusion.pdf - http://www.cerebral-palsy-information.com/cerebral_palsy_information/children_and_cerebral_palsy/teaching_cerebral_palsy_children.htm - http://www.ucpresearch.org/highlights/children-with-cp-botox-injections.php - http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm#What_research_is_being_done - http://www.ofcp.on.ca/guide.html#13 - **http://www.commonwealthfund.org/usr_img/895epsdt_chart2.gif** - http://pediatrics.aappublications.org/cgi/content/full/117/3/828 - http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm - http://www.cerebralpalsyinfo.org/types.php - http://www.ucp.org/ucp_general.cfm/1/3 - http://www.ucp.org/ucp_channeldoc.cfm/1/11/10427/10427-10427/447