PHYSICALLY DISABLED:CEREBRAL PALSY

By Elizabeth Blatz, Alexa D’Auria, and Claire Miksad

Definition of the DisabilityPhysically Disabled:

A disability that is caused by an impairment that may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these. A disability may be present from birth, or occur during a person's lifetime.

Physical Disabilities GroupsThere are two major groups:

• Neuromotor impairments

• Muscular/skeletal conditions

Neuromotor Impairment Definition

Conditions caused by damage to the central nervous system, which includes the brain and the spinal cord. This impairment limits muscular control and movement.

Examples: Cerebral Palsy, Epilepsy

Muscular/Skeletal Conditions Definition

Impairments that affect the limbs and muscles. People with these conditions usually have trouble with controlling their movements, but the cause is not neurological. Some need to use special devices and technology to do simple tasks like walking, eating, and writing.

Examples: Limb Deficiencies, Junior Arthritis

Cerebral Palsy Definition• Cerebral Palsy, also known as CP, is a disorder

that affects muscle tone, movement, and motor skills.

• CP is caused by brain damage that occurs before or during a child’s birth. It can also occur during the first three to five years of a child’s life.

• This kind of brain damage can also cause other health issues, like vision, hearing, and speech problems and also learning disabilities.

Types of Cerebral Palsy1. Spastic Cerebral Palsy- causes stiffness and

movement difficulties

2. Athetoid Cerebral Palsy- causes involuntary and uncontrolled movements

3. Ataxic Cerebral Palsy- causes a disturbed sense of balance and depth perception

4. Rigidity Cerebral Palsy- tight muscles that resist effort to make them move

5. Tremor Cerebral Palsy- uncontrollable shaking, interfering with coordination

Intellectual Levels Every 1 in 2 people who have CP has an intellectual

impairment. Children may have:

A shorter attention spanMotor Planning Difficulties (organization and sequencing)Perceptual DifficultiesLanguage Difficulties

Affects literacy and math skills. Due to their disability, children with CP need to concentrate

more on how they perform intellectually and communicate, because it does not come as easily to them.

Prevalence • Cerebral Palsy is one of the most

common congenital disorders of childhood

• About 500,000 children and adults of all ages in the United States have the condition

Characteristics• Underdeveloped motor skills

• Slow to reach developmental milestones (rolling over, crawling, walking)

• Abnormal muscle tone

• Decreased muscle tone- Hypotonia

• Increased muscle tone- Hypertonia (stiff and rigid)

• May favor one side of the body

• Unusual, awkward position

• May demonstrate difficulty with head control

• Possible seizures and tremors

Assessment• CP may be diagnosed very early in an infant known to be

at risk for developing the condition because of premature birth or other health problems

• Pediatricians and neurological specialists usually follow these children closely from birth so they can identify and address any developmental delays with muscle function

• Often doctors aren’t able to diagnose CP until they see a delay in normal developmental milestones (reaching for toys by 4 months, sitting up by 7 months)

• Abnormal muscle tone and poor coordinated movements beyond the expected age that it will disappear can also be signs of CP.

Etiology (causation) • The exact causes of most cases of Cerebral Palsy are

unknown, but many are the result of problems during pregnancy in which, the brain is either damaged or doesn’t develop normally.

• This can be due to infections, maternal health problems, or a genetic disorder

• Premature babies less than 3.3 lbs are at a higher risk for CP

• Also brain damage in early childhood can be the causes (Ex: lead poisoning, bacterial meningitis, malnutrition, car accident)

Treatment of Cerebral PalsyThere is no cure for Cerebral Palsy, but

treatment, therapy, special equipment and in some cases, surgery can help an individual who is living with this condition.

Types of MedicationThe most common medications used to treat

cerebral palsy include medications within these categories:

• Anticholinergics (uncontrolled body movements)

• Anticonvulsants (seizure medications)

• Antidepressants (depressions medications)

• Antispastic (muscle relaxers)

• Anti-inflammatories (pain management)

• Stool softeners

Type of Surgery• Gastroenterology Surgery- aims to improve the process of feeding,

digestion, and bladder or bowel functioning

• Hear Correction Surgery- can help improve hearing impairment and loss

• Medicine Related Surgery-Children experiencing chronic pain, or in need of constant and consistent doses of medication, may benefit greatly by the insertion of a pump that continuously disperses medication through the spinal column.• Baclofen pump – this is a device – about the size of a hockey puck – implanted in the

abdomen. It is connected to the spinal cord with a thin tube that threads under the skin.

• Lumbar puncture – before implanting the pump, neurosurgeons may perform a lumbar puncture to inject a dose of baclofen into the child’s spinal canal as a test measure.

• Orthopedic Surgery- to optimize potential for movement, balance, and coordination

• Neurosurgery- includes the Baclofen pump

• Vision Correction Surgery- can help improve vision impairment and loss

Placement: Early Intervention for Cerebral Palsy

• Pre-School - a great time to have a student become prepared for in academic-centered settingo Socialize with peers in a comfortable setting.

• Many children with cerebral palsy develop learning disabilities - start them in school as soon as possible.

• They may develop learning disabilities that are common among students with cerebral palsy: visual-perception disorders or developmental language disorders.

Placement for Cerebral Palsy● Depends on the type of cerebral palsy● “Mainstream” - recently becoming more common

○ Means to place the student in a general education classroom with non-disabled students.

● More Severe Cases - put child in art or music classes so they can have the opportunity to socialize with their peers.

● Keep in Mind: “Mainstream” could lead to bullying, ridicule, and isolation

Placement: What will benefit the child?

“Do not assume that simply because a school is for disabled children, it will best fit your disabled child.”

At the same time:“...do not force your child into regular

education if it is obvious that they would benefit from services offered at a special school.”

Who is involved in placing the child?In the early stages of planning education

for a student with cerebral palsy:

• Doctors

• Organizations

• ParentsThey help the school identify the special

services needed.

Teaching Other Children About Physical Handicaps and Cerebral Palsy

• Picture Books

• Chapter books with characters who have special needs are appropriate for older readers. Ask your child about the book when he or she is done -- maybe you'll be intrigued and read it yourself.

• Audio-visual materials - positive portrayals of children with disabilities. ("Sesame Street," routinely includes children with disabilities in their episodes)

• Websites with age-appropriate explanations and activities can be interesting and fun to explore.

Two Main Related ServicesPhysical Therapists (PTs)

The development and maintenance of motor skills, movement, and posture.

Occupational Therapists (OTs)

Concerned with a child’s participation in activities, especially those that will be useful in self-help, employment, recreation, communication, and aspects of daily living (e.g., dressing, eating, personal hygiene)

Related Services: Physical Therapists

• Exercises for increasing control of muscles.

• Assist in use of specialized equipment, such as braces, effectively.

• Massage and Prescriptive Exercises

o Also - swimming, heat treatment, special positioning for feeding and toileting, and other techniques.

Related Services: Physical Therapists, Cont.

• Encourage children to be as motorically independent as possible.

• Help develop muscular function and reduce pain, discomfort, or long-term physical damage.

• Dos and Don’ts:

o Sitting positions

o Activities in the classroom

o Exercise/play programs that children with and without disabilities can enjoy together.

Related Services: Occupational Therapists

• Help learn (or relearn) diverse motor behaviors:

o Drinking from a modified cup

o Buttoning clothes and tying shoes

o Pouring liquids and cooking

o Typing on a computer keyboard

• All can enhance a child’s physical development, independence, vocational potential, and self-concept.

Related Services: Occupational Therapists, Cont.

• Conduct specialized assessments.

• Make recommendations to parents and teachers regarding the effective use of appliances, materials, and activities at home and school.

• Many work with vocational rehabilitation specialists in helping students find opportunities for work and independent living after completing school.

Other Related Services

• Speech-language

pathologists (SLPs)

• Adapted physical

educators

• Recreation therapists

• School nurses

• Prosthetists/Orthotists

• Orientation and mobility

specialists

• Biomedical engineers

• Health aides

• Counselors and medical

social workers

Accommodations

• Check for accessibility in and

out of the classroom.

• For students in wheelchairs:

o Desks are at an accessible

height.

o Aisles are at an appropriate

width.

o SDRC (Student Disability

Resource Center) to have a

class moved to an

accessible location.

• If the student needs a notetaker,

they must be provided with one.

(Another teacher, assistant,

scribe, or student.)

• Computer Exams – Scribe must

be used.

• Assignments and exams - tape

recordings and oral

presentations are acceptable.

• EXTRA TIME

Accommodations, Cont.• Grading – Total Capability of Knowledge NOT Speed

o Example: Grade the student on how many math skills the student learned

over the course of an entire unit as opposed how quickly they were able to

solve problems on a test.

• Tape Recorder

• Alternate Activities – Walk, stand, sit in a variety of activities

o Keep them moving

o Activities that they are PHYSICALLY ABLE to do.

• Emotions – Chronic pain = emotional discomfort

Proper Edicate for Students in Wheelchairs

• Do not hang onto or lean on a wheelchair

("body-space”).

• Push the wheelchair ONLY if asked or if you

have offered and it has been accepted.

Materials/Equipment - Cerebral Palsy

• Braces

• Car Seats

• Casts

• Computers

• Cycles

• Dogs

• Walkers

• Wheelchairs

• Heavy Orthopedic Shoes - so that they can attach the brace to the shoe

• Elevator Chairs

• Ramps

• Lifts

Classroom Instructional Strategies• Use mnemonics such as SLANT (Sit up, lean forward, ask

questions, nod your head, track the teacher)

• Consider environmental issues: seating placement in classroom, workspace free from distractions, proximity seating, student remove all non-related materials from space.

• Use textured mats under worksheets and manipulatives to stabilize work area.

• Provide a paper stabilizer (clipboard, non-slip writing surface).

• Provide large-print handouts of text.

• Provide a bookstand for books and assignment pages.

Classroom Instructional Strategies

• Use digital timer to help pace student while working

• Use a line or a place-marker

• Use large pencils and/or pencil grips/weighted pencils

• Use adaptive equipment for posture: booster seats, arm rests, etc.

• Use computers with touch screen capabilities.

• Vary group size for instruction.

• Provide large-print handouts of text.

Classroom Instruction Strategies (cont.)

• Provide copies of work that is presented on the board or textbook to cut down on. “copying” for students.

• Vary group size for instruction.

• Use drawings and real-life examples such as lunch counts and class lists.

• Make available computer speech-enhanced text and lessons.

Top 10 Apps for Children With Cerebral Palsy

Tap to Talk Yes-No iComm First Then Visual Schedule

http://babieswithipads.blogspot.com/2013/05/top-10-apps-for-children-with-cerebral.html

Instructional Strategies for Reading Comprehension

• Use colored highlighters to direct attention to key information

• Use colored sticky notes to draw attention or clarify important information

• Comprehension monitoring and summarization:o stop at regular intervals while reading a texto determine whether or not they understand the texto summarize the main idea of each part of the text

● Graphic and semantic organizers

○ read the text

○ use organizational aids to map out the content of the text

○ illustrate visually the structure of the text’s meaning in a story map

Instructional Strategies for Reading Comprehension

● Question answering

○ read the text

○ answer questions about the text, posed by the teacher

○ receive immediate feedback on their answers

● Cooperative learning

○ interact with the peers about written texts

○ implement the other comprehension strategies with a peer or group of peers

○ discuss the text

● Question generation

○ think about the topic of the text

○ activate prior knowledge

○ generate questions themselves prior to reading or while reading

○ respond to the questions as they read

Reading Comprehension Activity http://teacher.scholastic.com/clifford1/flash/phonics/index.htm

Literacy Comprehension - Student Example

Gareth is 5 years old.

• Gareth has cerebral palsy. He has a tracheostomy.

• He uses a computer with speech output to communicate (specifically a Mercury with Speaking Dynamically Pro Software). He also uses a communication book with Mayer Johnson Picture Communication Symbols (PCS).

• We started to work with Gareth and his parents to teach him literacy skills when he turned 3 years old.

• Gareth loves books and was very motivated to learn to read.

This video was taken when he was 5 years old, just before he entered Kindergarten.

• Janice starts by giving Gareth a choice of literacy activities

• Gareth chooses to read a book about Clifford

Janice - points to the words in each sentence, one at a time in sequence

Gareth - looks at the written words, decodes the words or recognizes them by sight, puts the words together to determine the meaning of the sentence.

Janice - introduces a question answering strategy to build comprehension skills, writes out a question about the story (Who will race?)

Gareth - thinks about the question, relates it to the story, points to the answer on a communication board (the dogs)

Janice asks inference questions as well as factual ones (Why will Clifford win?)

At 5, Gareth has learned to read simple books independently and answer comprehension questions accurately.

He is a successful reader. His skills exceed those of many of his typically developing peers.

Literacy Comprehension Videohttp://aacliteracy.psu.edu/index.php/page/show/id/11

Instructional Strategies for Writing• Provide adapted paper (bold line, raised line,

enlarged spacing)

• Provide specifically lined/oriented paper

• Graphic and semantic organizers

• Focus on Phoneme Segmentation

o Essential for writing skills

o Break the word down into its component sounds

o Select the letters that represent those sounds

Instructional Strategies for Math

• When doing math, students with cerebral palsy have difficulty in math due to cognitive and motor variables.

• Word decoding and fine motor skills are the strongest predictors of arithmetic performance.o Demonstrate all concepts with

manipulatives.o Have them be familiar with the symbolic

number system.

• Usually delayed in counting, subitizing, and simple arithmetic operations - also use manipulatives.

Writing Activityhttp://www.bbc.co.uk/cbeebies/get-squiggling/games/get-squiggling-letters/

Post-Secondary/Vocational

•There are about 1.1 million physically disabled undergraduates in the United States (2010 U.S Census Bureau)

http://www.usnews.com/education/best-colleges/articles/2011/12/05/4-tips-for-college-applicants-students-with-physical-disabilities

Recreational Programs•Wheelchair basketball, baseball (Miracle league), football, handball,

track and field

http://cerebralpalsy.org/inspiration/breaking-barriers/adaptive-sports-in-the-public-school-system/

•Summer camps for children with Cerebral Palsy http://campforall.org/camptube/

http://www.needymeds.org/camps.taf?_function=list_disease&disease_id=152&disease=Cerebral%20Palsy

Recreational Programs Continued•Hippotherapy for Children with Cerebral Palsy

http://cerebralpalsy.org/about-cerebral-palsy/therapies/hippotherapy/

•Music and Dance Therapy

http://www.treatmentofcerebralpalsy.com/05-music-dancetherapy.html

•Acting as a movement therapy

http://www.ncpad.org/1106/5567/Acting~as~Movement~Therapy

http://www.ncpad.org/content/10/Fun~and~~Leisure

http://www.borp.org/about/

Organizations and Agencies•The American Academy of Cerebral Palsy and Developmental

Medicine

•International Cerebral Palsy Society

http://www.icps.org.uk

•Cerebral Palsy International Research Foundation

http://www.cpirf.org

•MyChild

http://cerebralpalsy.org/about-mychild/

•United Cerebral Palsy

http://ucp.org

Organizations and Agencies•American Academy for Cerebral Palsy and Developmental Medicine

http://www.aacpdm.org

•CaringChild.org

•Reaching for the Stars

http://reachingforthestars.org

•Cerebral Palsy Alliance

https://www.cerebralpalsy.org.au

Henry Viscardi School• Students can still be exposed to regular curriculum,

but with a wide variety of accommodations.

• Life-sustaining medical treatment throughout the day.

• Therapies and assisted technology.

• Pre-K - 12th Grade

• http://www.henryviscardischool.org/

Henry Viscardi School Videohttp://www.youtube.com/watch?v=J-4bhBS20xo

Henry Viscardi Clubs, Activities, and Experiences

• Student Government

• Viscardi Ambassadors

• Cougar Chronicle newspaper

and Milestone yearbook

• Natural Helpers® - a national

Peer Helping Program

• Theater Arts

• Friday Night Recreation

• Adapted Sports, including

Intramural Wheelchair

Basketball

• Independent Living Overnights

• Internships

Children’s Books• Nathan’s Wish by Laurie Lears

A focus on abilities, not disabilities

By featuring a main character with cerebral palsy that is coming to terms with his condition, “Nathan’s Wish” uses a compelling plot to show children that everyone is cherished.

• Romeo Riley by April M. Whitt

The Private Eye Series

Romeo Riley, the sleuth empowered by a wheelchair and electronic communication device, knows no limits when discovering trouble.

• Taking Cerebral Palsy to School by Mary Elizabeth Anderson and Tom Dineen

• Out of My Mind by Sharon Draper

Children’s Books• Petey by Ben Mikaelsen

In 1922, at the age of two, Petey's distraught parents commit him to the state's insane asylum, unaware that their son is actually suffering from severe cerebral palsy. Bound by his wheelchair and struggling to communicate with the people around him, Petey finds a way to remain kind and generous despite the horrific conditions in his new "home." Through the decades, he befriends several caretakers but is heartbroken when each eventually leaves him. Determined not to be hurt again, he vows to no longer let hope of lifelong friends and family torment him. That changes after he is moved into a nursing home and meets a young teen named Trevor Ladd; he sees something in the boy and decides to risk friendship one last time. Trevor, new to town and a bit of a loner, is at first weary of the old man in the wheelchair. But after hearing more of his story, Trevor learns that there is much more to Petey than meets the eye.

• Howie Helps Himself by Joan Fassler, Joe Lasker (Illustrator)

Professional Literature• Cerebral Palsy: A Complete Guide for Caregiving

by: Freeman Miller, Steven J. Bachrach, and Marilyn L. Boos• Cerebral Palsy: Everything You Need to Know About the Disease

Including Signs and Symptoms, Causes, Treatment and moreby: Gaby Alez

• Cerebral Palsy / Edition 1

by: Freeman Miller, E. Browne• Cerebral Palsy: From Diagnosis to Adult Life

by: Peter L. Rosenbaum, Lewis Rosenbloom• Finnie's Handling the Young Child with Cerebral Palsy at Home /

Edition 4by: Eva Bower

Webliography • http://www.ttaconline.org/staff/sol/eng_physical.htm

• http://teacherweb.com/ON/JohnMcGregorSecondarySchool/LearningandEnrichmentCentre/CerebralPalsy.pdf

• http://www.education.com/reference/article/physical-health-disabilities-defined/

• http://kidshealth.org/parent/medical/brain/cerebral_palsy.html

• http://www.bbc.co.uk/cbeebies/get-squiggling/games/get-squiggling-letters/

• https://www.youtube.com/watch?v=OZpiQH0zHAg&feature=player_embedded#at=194

• http://teacher.scholastic.com/clifford1/flash/phonics/index.htm

• http://aacliteracy.psu.edu/index.php/page/show/id/11

• http://www.usnews.com/education/best-colleges/articles/2011/12/05/4-tips-for-college-applicants-students-with-physical-disabilities

• http://www.icps.org.uk

• http://www.cpirf.org

• http://cerebralpalsy.org/about-mychild/

• http://ucp.org

• http://www.aacpdm.org

Webliography (continued) • http://cerebralpalsy.org/about-cerebral-palsy/treatment/medication-and-drug-therap

y/

• http://cerebralpalsy.org/about-cerebral-palsy/treatment/surgery/six-common-surgeries/#mr

• http://www.henryviscardischool.org/ http://babieswithipads.blogspot.com/2013/05/top-10-apps-for-children-with-cerebral.html

• http://disabilitycenter.fsu.edu/fac_guide.html#physical

• http://cerebralpalsy-educationandsociety.com/05-evaluations.html

• http://www2.ed.gov/pubs/OSEP95AnlRpt/ch1c.html

• http://www.cerebralpalsyaccessoriesandequipment.com/

• http://cerebralpalsy.org/inspiration/breaking-barriers/adaptive-sports-in-the-public-school-system/

• http://cerebralpalsy.org/about-cerebral-palsy/therapies/hippotherapy/

• http://www.treatmentofcerebralpalsy.com/05-music-dancetherapy.html

• http://www.ncpad.org/1106/5567/Acting~as~Movement~Therapy

Webliography (continued) • http://aacliteracy.psu.edu/index.php/page/show/id/6

• http://www.academia.edu/1452224/Arithmetic_performance_of_children_with_cerebral_palsy_The_influence_of_cognitive_and_motor_factors

• http://aacliteracy.psu.edu/index.php/page/show/id/11

• http://misthaven.hubpages.com/hub/cerebral-palsy-therapy-treatment

• http://www.care.com/special-needs-teaching-your-child-about-peers-with-special-needs-p1017-q598.html

• http://campforall.org/camptube/

• http://www.needymeds.org/camps.taf?_function=list_disease&disease_id=152&disease=Cerebral%20Palsy

• http://reachingforthestars.org

• https://www.cerebralpalsy.org.a

• https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/how-cerebral-palsy-affects-people/

• http://www.ncpad.org/content/10/Fun~and~~Leisure

• http://www.borp.org/about/