Cerebral Palsy
A permanent motor disability caused by brain damage associated with birth.
Cerebral palsy (CP) results from head injury after birth. The primary effects of cerebral palsy range from mild impairment of movement of one part of the body to severe impairment of most gross and fine motor functions. CP can also cause sight and hearing impairments, problems with depth perception and balance, learning disabilities, and mental retardation. Motor problems associated with CP often impair a person's ability to walk, talk, eat, breathe, speak, and control bladder functions, and he or she must receive significant support to perform the daily functions of living.
Cerebral palsy occurs in about 2.5 of every 1,000 live births, so that between 500,00 and 750,000 people in the United States have the disorder. In 30-75% of cases the original cause is unknown. Many birth-related problems associated with CP, such as German measles, RH incompatibility, and asphyxiation during labor, have been nearly eliminated, yet the incidence of CP has not declined accordingly. Some suggest that the relative increase in incidence of CP may be due to increased survival of premature infants. Research has also linked in utero formation of brain cysts with CP.
CP is primarily a problem of planning and controlling movement. Any movement of the human body consists of a delicately timed and coordinated process of muscle contraction (shortening) and expansion (lengthening). For example, to perform the fairly simple act of raising the hand to touch the face, muscles in the front of the arm (biceps) contract and tighten as the muscles in back (triceps) expand and loosen. Lack of coordination of changes in the two muscles results in jerky movement. The act of stopping the movement is as important as initiating and coordinating it. CP is categorized both by the type of muscle affliction and by the location of afflicted muscles.
There are three main types of muscle affliction: spastic, ataxic, and athetoid. In spastic CP, the afflicted muscles are extremely tight. People with spastic CP have stiff and jerky movements and difficulty letting go of objects they are gripping. About half of all CP is spastic CP. By contrast, people with the much rarer atoxic CP have very loose muscles and experience problems holding onto things. Shakiness and difficulties with depth perception characterize ataxic CP. In athetoid CP the afflicted muscles are sometimes too tight and sometimes too loose. Due to random muscle expansions and contractions people with athetoid CP have trouble sitting or standing up and experience involuntary movement of the face, arms, and upper body. About 25% of people with CP have athetoid CP, and another 25% have a combination of forms.
When muscles on all four of the limbs (and usually the trunk and face) are afflicted by cerebral palsy, it is called quadriplegia. When only one side of the body is afflicted, it is called hemiplegia. When only the legs are afflicted or the leg muscles are more severely impaired than the arms, it is described as diplegia. The set of speech problems caused by difficulties moving the jaws, lips, and tongue in persons with quadriplegia is called dysarthria.
School-Age Children with Cp
Disabilities associated with cerebral palsy are classified under the Individuals with Disabilities Act, which entitles children ages 3-21 to a "free, appropriate public education" to take place in the "least restrictive environment" (LRE). A team of professionals, including the regular teacher, special education teacher, and physical therapists, will perform an initial evaluation of the child's developmental needs and develop an Individualized Educational Plan (IEP) for the child that will be continually updated. Parents usually participate in the planning and evaluation process, and they must approve any changes in the IEP itself. In addition to regular educational goals, objectives for students with CP may include the areas of motor control and perception, augmentative communication, and living and leisure skills.
Increasing adoption of the policy of inclusion—maximum integration of special education students into the regular classroom—requires modification of the environment and the instructional design for students with cerebral palsy. Two of the most important factors in the success of inclusion, also called "mainstreaming," are (1) a high positive attitude on the part of the regular teacher and (2) the presence of an assistant to help the regular teacher modify instructional methods and procedures.
Some important beginning objectives for teachers with students having cerebral palsy are: (1) to modify the classroom environment to accommodate the student's movement, and (2) to become familiar with the student's primary and preferred methods of communication. The quadriplegic student in particular may use a combination of augmentative devices, including a "communication board" with symbols, words, and letters on it, a computerized communication device with a keyboard, digital display, and/or voice simulator, and a unicorn stick (strapped to the head) or other pointing device. Communication may be awkward at first, but given a supportive environment the teacher and other students will gradually learn the language of gesture, eye movements, and sound that many students with CP use to communicate.
For Further Study
Books
Aaseng, Nathan. Cerebral Palsy. New York: F. Watts, 1991.
Schleichkorn, Jay. Coping with Cerebral Palsy: Answers to Questions Parents Often Ask. 2nd ed. Austin, TX: PROED, 1993.
Sanford, Doris. Yes, I Can!: Challenging Cerebral. Sisters, OR: Multnomah Press, 1992. [juvenile literature]
Audiovisual Recordings
American Film Institute. About Annie. New York: Carousel Film & Video, 1989.
(One 9-minute videorecording about a teenage girl with cerebral palsy.)
Cerebral Palsy: Advances in Treatment and Technology. Cleveland, OH: Cleveland Clinic Foundation, 1992.
(One 2-hour videorecording.)
Organizations
American Coalition of Citizens with Disabilities
Address: 1346 Connecticut Avenue, NW
Washington, DC 20036
Telephone: (202) 785-4265
The Association for the Severely Handicapped
Address: 7010 Roosevelt Way, NE
Seattle, WA 98115
Telephone: (206) 283-5055
United Cerebral Palsy Association
Address: 7 Penn Plaza, Suite 804
New York, NY 10001
Telephone: (800) USA-1UCP
(A nationwide network of state and local voluntary agencies which provides services and conducts public and professional education programs. Direct services include medical diagnosis, evaluation, and treatment; therapy; assistive technology; information and referral; early intervention; employment; individual and family support; social and recreation programs; community inclusion and independent living; and advocacy and community education.)
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