CEREBRAL PALSY, TRAUMATIC BRAIN INJURY

AND STROKE

JESSICA SILVA JULIE MOORE

Introduction Cerebral Palsy (CP),

Traumatic Brain Injury (TBI) and Stroke are conditions that result in damage the brain.

They might exhibit common motor, cognitive and behavioral characteristics.

Cerebral Palsy (CP) Cerebral: Brain Palsy: disordered movement

or posture. Definition:

Group of permanent disabling symptoms as a result of damage to the control areas of the brain.

Non-progressive condition originated before, during or shortly after birth.

CP: Characteristics Loss or impairment of control over voluntary

musculature.

Symptoms vary widely: Total inability to control bodily movements (severe

cases) to mild conditions such as a speech impairment.

Abnormal reflex development.

Difficult to coordinate and integrate basic movements patterns.

CP is commonly associated with other impairments such as:SeizuresSpeech and language disordersSensory impairmentsAbnormal sensation and perceptionIntellectual disability

CP: Causes Rubella Rh incompatibility Prematurity Birth Trauma Anoxia Meningitis Poisoning Brain hemorrhages or tumors Other brain injuries caused by accident or

abuse.

CP: Incidence In 2010, 800,000 people were estimated

as having CP.

10% of the cases are acquired in the 2 first years of life.

CP: Classifications There are three different criteria to

classify the particular type of CP:1. Topographical – in accordance with the

anatomical site○ Monoplegia○ Diplegia○ Hemiplegia○ Paraplegia○ Triplegia○ Quadriplegia

http://physicaltherapydatabase.blogspot.com/2011/04/cerebral-palsy-part-ii.html

2. Neuromotor – From the American Academy for Cerebral Palsy

2.1 Spasticity: Results from damage to motor areas of the cerebrum, characterized by:

- Hypertonicity,- Problems with balance and locomotion.- More commonly associated with other

disorders.

2.2 Athetosis - Damage to the basal ganglia resulting

in a overflow of motor impulses to the muscles.

http://www.alinenewton.com/neuroscience.htm

Caused by blood incompatibilities during birth.

Slow and writhing movements uncoordinated and involuntary.

Abnormalities in muscle tones.

http://medical-dictionary.thefreedictionary.com/athetosis

Facial grimacing; Protruding tongue; Lack of head control; Difficulty in eating, drinking, and

speaking; Lordotic stand is common Aphasia: impairment or loss of

language.

2.3 Ataxia Damage to the cerebellum resulting in

balance and muscle coordination problems.

http://www.dana.org/news/brainhealth/detail.aspx?id=9774

Its usually diagnosed when the child tries to walk. – Wide-based gait.

Nystagmus: involuntary movement of the eyeball.

Difficult with basic motor skills.

3. Functional Classification

Based on the abilities possessed by the individual.

Which varies with the severity of the disability.

Used by the National Disability Sports Allience (NDSA) and the Cerebral Palsy-International Sport and Recreation Association to equalize competition.

The classification has 8 classes:Severe spasticity or athetosis with severe

locomotion and object control restrictions (Class I)

toMinimal coordination problems (Class VIII)

General Education Considerations Condition to be managed not treated.

Alleviating symptoms and promoting maximum potential in growth and development.

Strategies to alleviate symptoms Practice activities to train voluntary

muscle control and muscle relaxation. Promote the development of functional

motor skills. To avoid permanent contractures:

braces and orthotic devices.

Surgery on the tendons, muscles or the brain might be performed in severe cases.

Physical therapy

Social and psychological attention.

Keep in mind: primary concern is the total person.

Traumatic Brain Injury (TBI)Definition: Injury to the brain that might

produce a diminished or altered state of consciousness.

Possible impairments of physical, cognitive, social, behavioral and emotional functioning.

Causes Accidental traumas; Lack of oxygen (anoxia); Cardiac arrest; Child abuse; Near drowning

Motor vehicle accidents, violence and falls are the leading causes.

Characteristics Physical impairments might require the use

of crutches or wheelchairs.

Might involves: lack of coordination, spasticity, headaches, speech disorders, paralysis, seizures.

Disorders of motor planning - Apraxia: loss of the ability to execute or carry out learned purposeful movements.

Cognitive impairments might involve:Memory deficits, poor attention and

concentration, poor judgment, etc.

Social, emotional and behavioral impairments:Mood swings, difficulty in controlling

impulses, in relating with others; depression, etc.

Incidence TBI is the leading killer and cause of

disability d young adults (under 45). Affects more the 1.7 million persons on

the US each year (Thompson et al, 2012).

Young males are in more risk to sustain a TBI.

Classification Open Head Injury:

Usually comes from accident, gunshot, or blow to the head – visible injury.

Closed Head Injury:Caused by severe shaking, anoxia or cranial

hemorrhages – diffuse brain damage.

LEVELS OF SEVERITY

Accordingly with “The Ranchos Los Amigos Hospital Scale”:

- 8 levels of cognitive functioning varying from very severe to very mild condition:

- Level 1 – No response, coma. - Level 5 – Confused and inappropriate

response. Responds well to simple commands, highly distractible, in need of frequent redirection.

- Level 8 – Purposeful and appropriate behavior, doesn’t require supervision.

General Educational Considerations

First of all: Individualized rehabilitative program with a interdisciplinary team.

- Usually on the hospital facilities. Long term rehabilitation program. The

individualized educational program normally goes to the rehabilitation center.

- Lasts from 6 to 12 months, focus on cognitive skills, speech therapy, readaptation to daily live activities.

Basic Principles for Educators Provide each student with unique cognitive,

behavioral and psychosocial challenges. Assessments need to be functional and

contextualized. Systematically reduce in support offered as

appropriate. Collaborative decision making.

Develop additional instructions strategies: e.g.: cooperative learning activities, additional time to reviews. Simplify information and directions.

Development and implementation of transitional plans for high school-age students.

Focus on a functional transitional approach to establish links with community and postschool.

Stroke Also referred to as

cerebrovascular accident (CVA) Definition:

Damage to the brain tissue resulting from faulty blood circulation

Can result in serious damage to areas of the brain that control vital functions ○ Examples: Motor ability and control,

sensation and perceptions, communication, emotions, and consciousness

Can result in death

http://www.sciencedaily.com/releases/2009/03/090312114803.htm

CVA: Characteristics People who survive CVA have varying

degrees of disability Depending on the location of damage,

symptoms are similar to CP and TBI Common Characteristics:

Partial or total paralysis on either the left or right side of the body○ One limb (monoplegia) or body segment○ One entire side (hemiplegia)

CVA: Characteristics cont.

Right-sided hemiplegia○ Problems with speech and language○ Slow and cautious, and disorganized with

approaching new or unfamiliar problemsLeft-sided hemiplegia

○ Problems with spatial-perceptual tasks ○ Overestimate their abilities

CVA: Adult versus child characteristics Typically children experience the same

effects as adults do Research shows that children show

more improvement following brain trauma (TBI and CVA) than adults do

CVA: Classifications Two categories:

1. Hemorrhagic○ Hemorrhage within the brain as a result of an

artery that loses elasticity and ruptures 2. Ischemic (Majority)

○ Lack of blood results from a blocked arteryBlockage caused by progressively narrowing artery

or embolism (blood clot r piece of plaque that lodges in small artery)

CVA: Causes Several factors contribute to CVA occurring

Uncontrolled hypertensionSmokingDiabetes mellitusDietDrug abuseObesityAlcohol abuse

Most can be controlled through lifestyle changeModerate and high levels of physical activity are

associated with a reduced risk of CVA (Blair, 2003)

CVA: Incidence Primarily viewed as occurring in elderly, but it also

strikes infants, children and young adults Risk is greatest in the first year of life

Peaks during the perinatal period Occurs in about one of every 4,000 live births Risk from from birth through age 18 is nearly 11 per

100,000 children per year 50 to 80 percent of surviving children will have

permanent neurological effects One of top 10 causes of death for children CVA is a leading cause of long-term disability in the

United States

CVA: Considerations Teachers and coaches should be aware of

common warning signsSudden weakness or numbness of face Sudden weakness or numbness of arm and leg or entire

side of bodySudden dimness or loss of vision in only one eyeSudden loss of speech or trouble understanding speechSudden severe headache with no apparent causeUnexplained dizziness, unsteadiness, or sudden falls

Seek medical attention immediately Survivors immediately placed on a planned,

systematic and individualized rehabilitation program

CP, TBI and CVA Characteristics: Physical Reduced muscular strength, flexibility,

and cardiorespiratory endurance Inability to maintain balance or

independently transfer weight or moves one’s body

CP, TBI and CVA Characteristics: Motor Restricted from experiencing normal functional

movement patterns Delays in motor control and development

People with CP:Few opportunities to move + Lack movement ability +

Difficulty control movements People with CVA:

Difficulty planning and performing movements because of damage to the cerebrum

People with TBI and CVA: Unable to execute fundamental motor skills in an

appropriate manner

CP, TBI and CVA Characteristics: Behavioral Lack self-confidence Have low motivational levels Exhibit problems with body image

General Program Implications: Safety Cont. Students with severe impairments need

special equipmentSupport upper body while in the prone

position (crutches, bolsters, etc.)Assist in maintaining a standing posture

(standing platform)Aid in in performance of certain motor tasks

(orthotic devices, seating systems, etc.)

Implications to PE program: Recommended teaching strategies Safe, secure environment to explore capabilities of own

body and interact with surroundings Closely monitor games and activities Assist by:

Getting a student into and out of activity positions, physically supporting her during activity, or helping her perform a skill or exercise

Apply pressure with hands on key points of body Gradually reduce the amount of support to key points of

body over time Personalized approach to enhancing health-related fitness

Develop strength and flexibility Develop adequate level of aerobic activity

Implications to PE program: Recommended teaching strategies cont. Brockport Physical Fitness Test

(BPFT):Provides test items, modifications for

disabilities, and criterion-referenced standards for achieving fitness

Components of aerobic functioning, body composition, and musculoskeletal functioning

Various test items can be selected within components ○ Selection based on functional

classification http:/www.sciencedirect.

com/science/article/pii/S105827460800476X

http://www.todayfitness.net/onlinetrainer/TFOT-

skinfoldsites.htm

Implications to PE program: Recommended teaching strategies cont. Be sensitive to frequency, intensity,

duration, and mode of exercises and activities Rest breaks and player substitutions

Choose activities students find enjoyable

Implications to PE program: Recommended teaching strategies cont. Encourage the sequential development of

fundamental motor skills Authentic assessment

Be concerned primarily with the manner in which a movement is performedEcological Task Analysis (ETA)

Encourage students to achieve maximum motor control and development related to functional activitiesStandardized motor development tests

Implications to PE program: Recommended teaching strategies cont. Provide successful movement

experiences that motivate students and help them to gain self-confidence

Promote that failing is a natural part of the learning process

Implications to PE program: Recommended activities/exercises The club throw

http://www.youtube.com/watch?v=5b_JZIrbN1E

Bowling Cycling Archery Boccia

http://www.youtube.com/watch?v=CAlQzcqw0Zw&feature=relmfu

Tennis Table Tennis Riflery Archery Badminton Horseback riding Billards Track and field

http://www.blazesports.org/sports/archery/

http://www.blazesports.org/?cat=27

http://www.blazesports.org/?cat=26

Adapted Sports The National Disability Sports Alliance

(NDSA) administrates the participation of athletes with CP, TBI and CVA

Participation occurs on the basis of their functional ability levels as displayed on the eight-level classification system.

Placement Two testing procedures to determine

placement:1. Observation and questioning2. Measurement of speed, accuracy of

movement and rang of motion for upper extremity and torso function.

For ambulant athletes: assessment of lower extremity function and stability.

References1. Thompson, et al. Utilization and Costs of Health Care after Geriatric

Traumatic Brain Injury. Journal of Neurotrauma, n.29, pag. 1864-1871. July, 2012.

2. Knowing No Bounds: Stroke in Infants, Children, and Youth. Retrieved from: http://www.strokeassociation.org/idc/groups/

stroke-public/@wcm/@hcm/@sta/documents/downloadable/ ucm_311389.pdf

3. Winnick, Joseph P. (Ed.) (2011). Adapted Physical Education and Sport (5th ed.). Champaign, IL: Human Kinetics.