Cerebral Palsy

Cerebral Palsy

- Heterogenous group of motor function disorders

- Non-curable- Life-long condition- Non-progressive- May be congenital or

acquired

Prevalence- 1 in 500 babies or

0.2%- Occurs equally

among males and females

Causation- Insult / Injury to the brain

- In single or multiple areas of motor centers- E.g. Meningitis, bleeding in the brain

- Development malformations, failures- Cerebral dysgenesis

- Neurological damage- Illness- Lack of oxygen- Trauma to the head during labour and delivery

- Infections- Rubella, cytomegalovirus

Cerebral Palsy Affects:MovementsBalancePostureCommunicateEatSleepLearn

Assessment PracticesPhysical evaluation

Assessment toolsNeuroimaging

Interview Laboratory Tests

*Types CPAccording to- Neurologic deficits

- Extent of damage- Area of brain damage

- Type of movement disorder (and location of brain injury)- Spastic (80%) -- Upper motor neuron- Ataxic (5-10%) -- Cerebellar- Dyskinetic (5-10%) -- Basal Ganglion- Mixed (10%) -- Spastic & Athethoid

*Types CP

*Classification by Topographical Distribution

* Classification by Motor Function

*Degree of SeverityMild

- Can live independently, move without assistance; his or her daily activities are not limited.- 20%

Moderate- Require self help for assisting their impaired ambulation capacity- need braces, medications, and adaptive technology to accomplish daily activities.- 50%

Severe- Totally incapacitated and bedridden, significant challenges in accomplishing daily activities.

No CP - Signs of CP, but impairment acquired after completion of brain development - Incident that caused the cerebral palsy Eg. Traumatic brain injury or encephalopathy

*SymptomsEarly SignsBaby Below 6 Months- Head lags when picked up- Stiff and/ or floppy

Baby Older than 6 Months- Does not roll over- Cannot bring hands together- Difficulty bringing hands to mouth

General Symptoms- Posture / balance problem- Loss of control or coordination- Abnormal tone- Abnormal strength- Abnormal reflexes- Persistent motor delay- Cognitive deficit- Associated handicaps

*Associated Problems

*Associated Problems

*Pain - Contractures, Abnormal postures, Skin breakdown

Hands-On Activity (5-7min)Goal: To experience what it is like to have cerebral palsy or a caregiver

Client’s goal: To put on and button a shirtCaregiver’s goal: To encourage independent function

Hands-On Activity (5-7min)Instructions

1.Get into pairs2.Choose A & B3.Be given your scenario4.Prepare for the scenario5.Begin

Hands On Activity (5-7mins)Fine Motor Impairment + Associated ProblemsScenarios:

- Blind- Deaf- Speech Impairment- Arm spasticity - Scissor Leg Gait

Hands-On Activity: Sharing

What’s your experience?

*Impact of Disability: Intelligence & Perception

Intelligence- Mental retardation- Learning difficulties- Working Memory- Numeracy- Literacy

Perception- CNS damage- Sensory integration

dysfunction - Difficulty processing

sensory cues- Difficulty judging distances

*Impact of Disability: Language- Information input

- Auditory information processing- Muscular control

- Over muscles of the mouth, tongue, throat- Respiratory coordination

- Communication output- Disjointed speech- Slurred speech- Cued speech / Sign language- 1 in 4 cannot talk

*Impact of Disability: Language

- Augmentative & Alternative Communication- Any device, system or method that improves the

ability of a person with a communication impairment to communicate effective

- Types- Aided communication: low-tech, high-tech- Unaided communication: facial expression,

gestures

*Impact of Disability: Social- SelfAdolescence- Research found lower self concept in females →

physical appearance, social acceptanceAdults- Less participation in social interactions, employment,

marriage and independent living compared to adults without CP

*Impact of Disability: Social

*Impact on the Family- Adequate knowledge helps family to cope

better- Frustration - Financial costs- Need for behaviour management- Financial costs- Social Stigma

*Impact of Disability: Personality DevelopmentChallenging behaviours

Cerebral Palsy Alliance Singapore- Established in 1957- Formerly Spastic Children’s Association of

Singapore - Vision: Empowering all persons with CP to

realise their full potential and lead fulfilled, dignified lives.

Educational PathwaysEarly Intervention Programme for Infants and Children (EIPIC)- Students: 6 months - 6 years- Provide early intervention- Prepare them for admission into Special Ed or mainstream school- Provide holistics and individual development programmes

- Interdisciplinary team: interventionist, physiotherapist, occupational therapist, speech and language pathologist, social worker, psychologist

- Curriculum domains: cognitive, adaptive, social, fine motor, gross motor, social-communication

Educational PathwaysCerebral Palsy Alliance Singapore School

- Students- Junior levels (7-12 years)- Senior levels (13-18 years)

- Curriculum- SPED- Learning outcomes: living, learning, working- Domains: social-emotional, academic (literacy, numeracy, science), daily living,

vocational, physical education and sports, the arts- Programmes

- Academic: OWL- Functional: EAGLE- High Support: DOVE

- Community Integration Activities- Total Defence Day, Racial Harmony Day, National Day

- Co-curricular Activities- E.g. boccia, music and dance, scouts, special arts, swimming, deskbells and percussion

Educational Pathways- Sensory impairment

- PSLE- Mainstream education

- Intellectual disability - Vocational education programme- Delta Senior School or Metta School- National vocational certification

- ITE Skills Certificate - WDA Workforce Skills Qualifications

- Others- Training centres / workshops- Volunteer Welfare Organisations - Open employment or - Sheltered workshops / Work activity centres

Educational Implications (1)Collaboration- Necessary to ensure successful experiences

and support teachers to solve learning and behaviour problems

- Specialist support- Physical therapist, occupational therapist,

educational psychologist, speech language pathologist, orthotist, counsellors, social workers

Educational Implications (2)Environmental Modifications- Accessibility and mobility

within school- Transportation and mobility

between home and school- Toileting needs- Seating arrangements,

desks, worktops

Educational Implications (3)Teaching Modifications- Special allowances for

academic requirements- Reduced workload- Extra time for completing

assignments, examinations

Educational Implications (4)Assistive Technology- Any systematic device

or method for accomplishing a practical task

- Mobility devices- Communication devices- Writing implements

AssessmentsAssessments- Intelligence Tests

- Vineland- WISC- Waschler

- Academic performance- Capacity to learn

- Others- Adaptive delay or

impairment- Communication level- Emotional status- Health- Motor abilities- Social ability- Vision and Hearing

Realised Potential, Fulfilled Lives

THANK YOU

Suggested VideosSingapore case study of CP: https://www.youtube.com/watch?v=PyxJmHi6atk Singapore Unsung Heroes: https://www.youtube.com/watch?v=-OIvZTOI3GwSingapore National Cerebral Palsy Football Team: https://www.youtube.com/watch?v=kg07tCb8ddkMaysoon Zayid on TED: https://www.youtube.com/watch?v=buRLc2eWGPQ

Further Sources- http://www.cpas.org.sg/ - https://www.cerebralpalsy.org.au- http://www.originsofcerebralpalsy.com/- http://www.cdc.gov/ncbddd/cp/data.html- http://cerebralpalsy.org/about-cerebral-palsy/

types-and-forms/- http://www.cdc.gov/ncbddd/cp/facts.html

ReferencesChallenging Behaviour and Cerebral Palsy, Capability Scotland, http://www.capability-scotland.org.uk/media/57694/challenging_behaviour_and_cerebral_palsy_12.pdf Emerson, E., Cummings, R., Barrett, S., Hughes, H, McCool, C. & Toogood, A. (1988). Challenging behaviour and community services: 2. Who are the people who challenge services? Mental Handicap, 16, 16-19.Olawale, O. A., Deih, A. N., & Yaadar, R. K. (2013). Psychological impact of cerebral palsy on families: The African Perspective. Journal of Neurosciences in Rural Practice, 4(2), 159-163.Penner, M., Xie, W. Y., Binepal, N., Switzer, L., & Fehlings, D. (2013). Characteristics of pain in children and youth with cerebral palsy. Pubmed. doi: 10.1542/peds.2013-0224.Shapiro, B. (2008). Health and well being of adults with cerebral palsy. Current Opinion in Neurology, 21(2), 136-142. doi: 10.1097/WCO.0b013e3282f6a499.Shields, N., Murdoch, A.,Loy, Y., Dodd, K. J., & Taylor, N. F. (2006). A systematic review of the self-concept of children with cerebral palsy compared with children without disability. Developmental Medicine & Child Neurology, 48(2), 151-157. doi: http://dy.doi.org/10.1017/S001262206000326.Nomanbhoy D.M., & Nonis K.P. (2004).Learners with Physical Disabilities. In Levan Lim & Marilyn Mayling Quah (Eds.) Educating Learners with Diverse Abilities. Singapore: McGraw-Hill EducationReddihough, D. S., & Collins, K. J. (2003). The epidemiology and causes of cerebral palsy. Australian Journal of physiotherapy, 49(1), 7-12.