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What is a physical disability? A physical disability can be classified as a physical condition that affects a person’s mobility, physical capacity, stamina or dexterity. The purposes of this assignment is to act as an introduction to Cerebral Palsy, its possible causes, characteristics, assistive technologies that are available to support both medically and physically for the person with cerebral palsy. It will also review activities that can be undertaken within the classroom for inclusion and also how the role of the special needs assistant (SNA) features for the child.
Cerebral, meaning of the brain and Palsy, meaning the affectation of movement and posture. Cerebral palsy happens before birth due to lack of oxygen, maternal infection or brain malformation. During birth, if there is a complicated labour or delivery which would cause problems with the babies breathing or circulatory system, or if baby was in a breech position where the baby is feet first instead of head first when labour begins. It can also occur during after birth or in very early childhood after birth before the brains growth has reached a particular level of maturity. This could be through brain injury after birth, low birth weight where a baby is less than five pounds (5lbs), premature (>37weeks of pregnancy), suffocation after birth or infection of the central nervous system.
Cerebral palsy is the most frequent physical disability, occurring is approx. 1:500 births. However, it is not an inherited disability. Cerebral Palsy is found across all family types irrespective of maternal age or social background. It not progressive and will not worsen over time/with age. Early therapies and treatments can reduce symptoms and improve mobility. The condition itself does not change but the individual with cerebral palsy will become increasingly better at managing it as they get older through therapy, training and education.
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Cerebral Palsy is a term used to refer to a group of conditions, not just one condition, that result in physical impairment, which affects the posture, muscle tone and movement of a person. Cerebral Palsy is, generally, characterised by a poor sense of balance, involuntary jerky movements, speech impairment and spastic muscle impairment. Cerebral Palsy comes from damage to the areas of the brain that control movement which can be either the result of damage or failure in the development of that particular part of the brain. The severity vary from person to person across a broad spectrum from mild to severe. It is important to note that there is variation in the manner in which cerebral palsy affects each individual. Depending on what area of the brain has been affected the child may have communication difficulties, learning capacity, movement and control difficulties, difficulties in ordering information and processing information while for others the cerebral palsy may be so mild it us hardly noticeable.
Cerebral Palsy has several different forms. Physically it can present with fisting and scissored legs, contracted hips, knees and feet, contractures on the left/right side of the body or asymmetric neck reflex.
Characteristics further outlined below:
Spasticity – this is the disordered control of movement. This is when a person’s muscles feel stiff and are hard for them to control. This can limit the range of movement and see increased reflex activity. There may be poor control of the head which may lead to difficulty in articulation, speech, feeding. There may also be problems with visual perception.
Paraplegia – This impacts the trunk and legs and causes increased muscle tone, known as spasticity which can cause:
- Abnormal movements
- Movement inhibition
- Delayed developmental milestones for moving
- Difficulties controlling muscle movement
- Difficulty moving from one position to another
Hemiplegia – this is when one side of the body, only, is affected. This is usually the arm more than the leg. Most children with hemiplegia can walk.
Quadriplegia – this is when both the upper and lower limbs and body are impacted and severely restrict mobility.
Diplegia – this is when half of the body, either upper or lower is affected. Many people with this type of cerebral palsy can still walk with some impairment and may need to use assistive devices.
Children with CP may experience emotional issues due to the physical limitations they experience. While their peers are running faster, working in class faster, able to answer questions in class, children with CP may feel left behind when they cant keep up across any of these areas. What can also cause issues for children with CP may be that they know the answers in class or while completing their school work but their physical challenges make it harder for them to complete these work tasks at the same pace as other children may prove to be intimidating in the school space for them. Children with CP may not be able to properly express themselves in these instances and this may lead to emotional difficulties for the child.
Whilst cerebral palsy does not necessarily cause other conditions there are a number of health issues that co-exist with it:
- Speech impairment – people with CP may have difficulty controlling the muscles used for speech such as the lips, tongue, diaphragm, or vocal folds. There may also be an issue with speech sounds where problems with articulation and phonological processes.
- Vision impairment where the person may have difficulty with eye muscle control, lazy eye, astigmatism, near or far sightedness and loss of peripheral vision.
- Hearing loss/impairment – this refers to any impact on the ability to hear sound. Hearing loss is measured in slight/mild/moderate/severe and profound. This loss could be conductive, issue with the outer or middle ear, sensorineural, issues with the inner ear or auditory nerve or mixed, where there is an element of both presenting in the child.
- Feeding problems and/or nutritional deficiencies due to tongue trusting/gagging/choking. They may also experience vomiting and regurgitation where stomach acid is regurgitated into the oesophagus. This may lead to aspiration where saliva or vomit is inhaled into the lungs which can lead to respiratory problems.
Over time there has been specialised equipment created to help to ensure that a child can enjoy a better quality of life, called assistive technology. This refers to any item, piece of equipment, software program or product system that can be used to increase, maintain or improve functional capabilities of persons with disabilities. Assistive technology can be high, such as specialised computers, or low tech, such as communication boards. This technology should help the person/people who have difficulty speaking, writing, pointing, seeing, hearing, learning and walking among many other things.
For people with cerebral palsy there are a number of aids, both physical and medical that can be used such as:
- Orthotics – the use of splints or braces
- Wheelchairs and wheelchair standers
- Communication aids – such as tablets – pecs boards –
- Posture and positioning aids – to ensure the right form and ensure there are not sores.
- Use of Baclofen injections– this is a muscle relaxer which is used to treat muscle issues such as spasm, pain and stiffness.
- Medicinal Botox injections can used to temporarily relieve muscle spasticity
There are a number of aids that can be used specifically for school to aid with learning/participation in the class:
- Slanted work station
- Braces
- Crutches
- Wheel chairs
- Communication aids such as specialised apps on tablets or PECs boards.
As the special need’s assistant specific to a child who has cerebral palsy there is a role that is needed to ensure full learning for the child. As an SNA you play a critical role in enabling the child with cerebral palsy to become more independent.
Conclusion
In the first instance I am there to ensure that the child has full accessibility to the class. This is one of the more important issues for a child with CP. The school environment should not exclude the child and the SNA will ensure the right physical adaptations are in place for the child. This could mean a special toilet, ramps at ingress points to the school/class if needed, grab rails, a lift if applicable and an area within the school for any specialised equipment that is required. Accessibility is a key feature for the child with CP as the motor area of the brain is affected and they will likely require a wheelchair or walking sticks for movement. The classroom may need to be reorganised for the child to ensure that the child has safe access to learning, there is wider space between the table banks and that the child is included as fully as possible as much as possible within the classroom.
References
- Cerebral Palsy Organization – Definition of Cerebral Palsy
- Mayo Clinic – Cerebral Palsy Symptoms and Causes
- Centers for Disease Control and Prevention – Facts about Cerebral Palsy
- American Speech-Language-Hearing Association – Cerebral Palsy
- The Journal of Pediatrics – Causes, Clinical Features, and Outcomes from a Prospective Study of Cerebral Palsy in the United Kingdom
- National Health Service (NHS) – Causes of Cerebral Palsy
