Cerebral Palsy

FACT SHEET

Cerebral palsy is a term used to describe a group of chronic conditions affecting body movement and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development; before, during or shortly following birth; or during infancy. "Cerebral" refers to the brain and "palsy" to muscle weakness/poor control. Cerebral palsy itself is not progressive (i.e., it does not get worse); however, secondary conditions can develop which may get better over time, get worse, or remain the same. Cerebral palsy is not communicable. It is not a disease and should never be referred to as such. Although cerebral palsy is not "curable" in the accepted sense, training and therapy can help improve function.

TYPES OF CEREBRAL PALSY

· Spastic cerebral palsy. In this form of cerebral palsy, which affects 70 to 80 percent of patients, the muscles are stiffly and permanently contracted. Doctors will often describe which type of spastic cerebral palsy a patient has based on which limbs are affected, i.e spastic diplegia (both legs) or left hemi-paresis (the left side of the body). The names given to these types combine a Latin description of affected limbs with the term plegia or paresis, meaning paralyzed or weak. In some cases, spastic cerebral palsy follows a period of poor muscle tone (hypotonia) in the young infant.

· Athetoid, or dyskinetic cerebral palsy. This form of cerebral palsy is characterized by uncontrolled, slow, writhing movements. These abnormal movements usually affect the hands, feet, arms, or legs and, in some cases, the muscles of the face and tongue, causing grimacing or drooling. The movements often increase during periods of emotional stress and disappear during sleep. Patients may also have problems coordinating the muscle movements needed for speech, a condition known as dysarthria. Athetoid cerebral palsy affects about 10 to 20 percent of patients.

· Ataxic cerebral palsy. This rare form affects the sense of balance and depth perception. Affected persons often have poor coordination; walk unsteadily with a wide-based gait, placing their feet unusually far apart; and experience difficulty when attempting quick or precise movements, such as writing or buttoning a shirt. They may also have intention tremor. In this form of tremor, beginning a voluntary movement, such as reaching for a book, causes a trembling that affects the body part being used and that worsens as the individual gets nearer to the desired object. The ataxic form affects an estimated 5 to 10 percent of cerebral palsy patients.

· Mixed forms. It is not unusual for patients to have symptoms of more than one of the previous three forms. The most common mixed form includes spasticity and athetoid movements but other combinations are also possible.

CHARACTERISTICS

• Underdeveloped motor skills
• Slow to reach developmental milestones (rolling over, sitting, crawling, smiling, walking)
• Abnormal or vacillating muscle tone
• Decreased muscle tone- Hypotonia
• Increased muscle tone- Hypertonia (stiff and rigid)
• May favor one side of the body or one movement pattern
• Unusual and often awkward posture
• May walk on tip toes or may carry arms high in “high guard position” for balance
• May focus locally on surroundings and not view the larger play area – may demonstrate poor visual acuity
• When under age 3 may demonstrate difficulty with head control and older may hold head in awkward position
• Possible seizures and tremors – often take medication to reduce frequency

CAUSE

A large number of internal and external factors can injure the developing brain and may lead to cerebral palsy or cerebral palsy like conditions. One identified cause of cerebral palsy is an insufficient amount of oxygen reaching the fetal or newborn brain. Oxygen supply can be interrupted by premature separation of the placenta from the wall of the uterus, awkward birth position of the baby, labor that is too long or too abrupt, or interference with circulation in the umbilical cord. Premature birth, low birth weight, RH or A-B-O blood type incompatibility between mother and infant, infection of the mother with German measles or other virus diseases in early pregnancy, and microorganisms that attack the infant's central nervous system also are risk factors for cerebral palsy. Most causes of cerebral palsy are related to the developmental and childbearing processes and, since the condition is not inherited, the condition is often called congenital cerebral palsy. A less common type is acquired cerebral palsy, usually occurring before two years of age. Head injury is the most frequent cause, usually the result of motor vehicle accidents, falls, or child abuse. Another possible cause of post child bearing cerebral palsy like conditions include severe brain infection.

ETIOLOGY AND PROGNOSIS

Cerebral Palsy is not a progressive disorder. A person with the disorder may improve somewhat during childhood, if they receive extensive care from specialists. Some individuals with the disorder will need to stay under the immediate care of another person for their entire lives, while others have a mild enough case to pursue fully independent lives.

IMPLICATIONS FOR PHYSICAL EDUCATION

• Elementary School- Sensory-motor and perceptual motor activities, relaxation
• Middle School- Muscle stretching, strengthening, and awareness, exercises, relaxation
• High School- Transition activities to use in community-based settings and exposure to sports included in U.S. Cerebral Palsy Athletic Association competitions

ASSESSMENT SUGGESTIONS

· Authentic Assessment- Testing that provides the teacher with the needed information to develop a meaningful physical education program

· Criterion- Referenced Test- Determine whether a skill has been mastered, it is not compared to other students in the class.

RECOMMENDED ACTIVITIES

· Stretching: Stretching of muscles is done by moving the arms or legs in a way that produces a slow, steady pull on the muscles to keep them loose. Children with cerebral palsy have increased tone and tend to get very tight muscles. Therefore it is extremely important to perform daily stretches to keep arms and legs limber so the child can continue to move and function.

· Strengthening: Strengthening exercises work specific muscle groups to enable them to support the body better and increase function.

· Positioning: The body is placed in a specific position to attain long stretches. Some positions help to minimize unwanted tone. Positioning can be done in a variety of ways, including: bracing, abduction pillows, knee immobilizers, wheelchair inserts, sitting recommendations, and handling techniques.

Riding a specially adapted tricycle can be very exciting and provides excellent exercise. An outdoor activity that can benefit almost any child with cerebral palsy is swimming. Not only does swimming give children a freedom of movement they don’t have on land, but it can also help improve respiratory ability. It is important to note that cold water can increase muscle tone, but warm water often has a relaxing effect and help reduce muscle tone. This means you should look for a pool with a water temperature best suited to your child’s tone. Other activities you may want to investigate once your child reaches school age include therapeutic horseback riding and Special Olympics/Paralympic opporutunities.

EFFECTIVE TEACHING STRATEGIES

• Work on muscle stretching and reduction of tone (work closely with PT)
• Gross motor skills to include those that work away from midline (e.g. sliding)
• Modify equipment:
• use ball sacks, balloons or beach balls
• modify rules of games
• enlarge targets
• use large scooters
• extensions for tag games
• Always consider safety issues, make sure the class understands the rules and modifications of activities. ALWAYS include a student with any disability in the class, do not leave them standing on the sideline.
• Students with cerebral palsy do not always demonstrate appropriate use of reflexes, especially protective and postural reflexes found with typical development.

RESOURCES

http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm

Cerebral Palsy Multimedia Tutorial
http://hsc.virginia.edu/cmc/tutorials/cp/cp.htm
Excellent multimedia description of a child's life with cerebral palsy. Therapy, equipment and problems are described along with more personal topics.

CP Parent List Archives
http://maelstrom.stjohns.edu/archives/cpparent.html
Publicly accessible archives for the CP Parent listserv are a great resource for parents who wish to catch up on discussions on the list or search for a particular topic.

United Cerebral Palsy (UCP) Research Fact Sheets
http://www.ucpa.org/ucp_generalsub.cfm/124/4/24
Summaries of research on cerebral palsy covering a number of years - informative but easy to read.

Scope
http://www.scope.org.uk
Scope is the United Kingdom's largest charity providing support and services for children and adults with cerebral palsy, their families and carers. Online articles address lifestyle issues such as cerebral palsy and aging and cerebral palsy and pregnancy.

REFERENCES

http://www.asdk12.org/Depts/ape/common/cerebralpalsy.html

http://en.wikipedia.org/wiki/Cerebral_Palsy

http://www.ndsaonline.org/

http://gait.aidi.udel.edu/res695/homepage/pd_ortho/clinics/c_palsy/cpweb.htm