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The numerous symptoms that the child
will experience range from mild to severe.
Several symptoms are mental retardation,
learning disabilities, seizures, difficulties
with motor skills, and vision, hearing,
and speech problems
(2,6). Every
child with CP has different symptoms,
so therapy methods must be personalized
for each individual patient. Since there
is no 'absolute' treatment, medical
professionals will have differing views
on the proper therapies needed. It is
crucial that a physician and a team
of health care professionals work hand-in-hand
to determine the appropriate course
of treatment (3).
The goal of each method of therapy must
focus on the organic (physical fitness),
neuromuscular (coordination), interpretive
(cognitive), social, and emotional development
of the child (8).
Before planning a model of therapy,
a medical professional must have a thorough
knowledge of the disorder in order to
decide which developmental objective
has highest priority.
There are four types of CP: spastic,
ataxic, athetoid, and mixed. Spastic
is the most common, is recognized among
70-80% of all CP cases, and is often
seen in premature babies (2,6).
Normal muscle functioning is characterized
by contraction and relaxation of agonist
and antagonist muscles resulting in
muscle tone and strength. In spastic
CP, both muscle sets are highly active
simultaneously and so become very stiff.
This results in jerky movements when
the rigid muscles are forced to stretch
or function (5).
The child has major difficulties when
moving from one bodily position to another
or releasing an object from their hand,
called a 'clasp-knife' situation due
to the non-coordination of muscles.
If spastic CP is not treated properly,
it will result in contractures of muscles
due to chronic hypertonicity. This produces
permanent disabilities and requires
surgery (8,5).
Spastic CP has 5 subcategories depending
on the body part affected:
Most common is spastic
diplegia. This condition is characterized
by scissoring of the legs, with tight
hips and leg muscles causing crossing
at the knees and the legs to turn inward.
The ataxic
form of CP is characterized by weak
muscles and low muscle tone. This disorder
is recognizable in children if they
are very unsteady or shaky. Problems
will result with balance, depth perception,
and difficulties with fine movements
such as writing or turning a page (2,4).
Approximately 10% of children with CP
will experience this form (4).
The athetoid,
or dyskinetic
form of CP, can be recognized in 20%
of individuals with CP. It affects the
entire body and is the result of varying
muscle tone, from too tight to too weak,
often associated with uncontrolled,
slow, writhing movements. Some of these
involuntary features are turning, twisting,
facial grimacing, and drooling. Individuals
with this disorder will struggle with
upright positions and walking, as well
as muscles of the face and tongue experiencing
difficulties with sucking, swallowing,
and speech (6).
Mixed CP occurs when 2 or more types
of CP are present in a child. Improved
diagnostic techniques are producing
more evidence for mixed CP (2).
Medical scans, such as MRIs, CT scans,
and ultrasound, can aid doctors in identifying
brain abnormalities. These are normally
diagnosed by the age of 5 as developmental
problems become perceptible. This allows
therapy to begin immediately upon birth
or diagnosis. The brain imaging tests
do not always expose the abnormality,
so often diagnosis depends on the appearance
of symptoms or early signs of CP (2,6).
A doctor will evaluate the muscle tone,
check for the existence of primitive
reflexes that normally disappear at
6-12 months of age, and determine if
the baby is favoring one side of their
body before reaching 6 months (12 months
is the norm). The doctor will also examine
the baby's motor skills, searching for
any difficulty with learning to roll
over, sit, crawl, or walk (6).
Some newborns may exhibit major symptoms
at birth, and others may not show signs
for a long time. Professionals in the
field must also pay attention to risk
factors and common causes of CP to help
anticipate the disorder when symptoms
are not immediately existent. It is
widely believed that lack of oxygen
reaching the fetus during labor and
delivery is the most prevalent cause
of CP, but it only contributes to a
small percentage. Some of the known
causes of CP are infections during pregnancy
(such as rubella or German measles),
blood diseases such as Rh disease, bacterial
and viral infections, sexually transmitted
diseases, raised temperature of the
mother, and when the mother abused drugs,
alcohol, or smoking. Premature babies
weighing less than 3 1/3 pounds are
30 times more likely to develop CP.
If a newborn suffers severe jaundice,
meningitis, or other birth defects are
present, the risk also increases (2,6,7).
There is no cure for the disorder,
but there are a variety of therapies
that aid a child in achieving as much
as he or she is capable of. The intention
of physical therapy is to avoid muscle
atrophy and contracture, while improving
the motor skills of a child with CP.
Therapists can use physical, occupational,
speech, and language therapy. They may
also employ biofeedback, medication
to help control seizures and spasticity,
and as a last resort surgery when the
child has been living with extreme contractures
that are unresponsive to the other means
of therapy (2,3).
The motor development of the child,
or the organic and neuromuscular objectives
of physical education, remains the primary
focus of any therapy method for CP.
One very promising therapy method,
entitled the MOVE
Curriculum, was created at the Blair
Learning Center in California in 1986.
This therapy is centered on the idea
of functioning in society. MOVE
focuses on the technician providing
support, motivation, and high expectations
for the child to assist the development
of functional motor skills. It was fashioned
for a school environment, but can also
be accomplished at home to help children
with everyday tasks. It is a top-down,
activity based curriculum focusing on
the skills of standing, walking, and
sitting, instead of developmental skills
such as raising your head from a prone
position, rolling over, and crawling.
The therapy team will select activities
based on real outcomes, and will then
incorporate instruction into these routinely
occurring events. Equipment for physical
support of the child is allowed, with
the support being reduced as skills
increase. This method changes lunchtime
from a daily routine to an instructional
opportunity; the child moves from sitting
to standing, bears weight to wash hands,
walks back to the table, and maintains
balance to sit up-right in a chair to
eat. The therapy team of the parents,
family, and school administrators can
also include cognitive, communication,
and socialization goals, allowing for
goals focusing on the needs of the individual.
MOVE
was developed as a functional curriculum
with learning occurring within meaningful
activities. MOVE
is meant to be utilized in natural environments
so skills can be practiced where they
will be used. It is a family centered,
integrated therapy with the team planning,
setting goals, and guiding a child with
instruction and by example. And, most
importantly, MOVE
involves as much participation as is
possible from the child during these
essential activities. The activities
taught are age-appropriate, increase
independence and access to the community,
and reduce personal care. This aspect
is extremely significant when you consider
the average lifetime cost of an individual
with CP in 2003 was $921,000 greater
than a person without a disability (7,9).
One example of mobility training using
the MOVE Curriculum was documented
in the magazine Teaching
Exceptional Children. Breanna was
a 4 year old girl who contracted meningitis
and encephalitis at 3 1/2 weeks. This
resulted in CP with high and low muscle
tone and little strength. Surgery was
highly recommended. Her mother, Trellis,
decided to administer the ideas of MOVE
for teaching Breanna walking skills.
She used activities such as feeding
the dogs and chickens, checking for
eggs, walking to grandmother's house,
and picking flowers in the yard. Breanna
participated fully, and Trellis kept
records of her progress.
In the first week, the mean number
of steps Breanna took with her mother's
assistance was 15, and her mean standing
time was 45 seconds. Six months later
Breanna could take 509 steps with her
mother's assistance, and had a mean
standing time of 4.02 minutes. Surgery
is no longer being considered. Trellis
quickly realized that creating more
interesting activities motivated her
daughter to participate. The instruction
of fun gross motor skills, such as walking
to a room to paint, had more beneficial
results with Breanna as compared to
discrete, boring motor skills being
taught. She now has better balance and
trunk control, as well as mobility,
which will positively affect her relationships
with others.
MOVE is most influential if every person
involved with the training believes
in the child and pushes him or her to
improve. Trellis at first was very frustrated
and remarked to her husband: "I
don't want to sit here and hold Breanna
for the rest of her life. I want her
to get up and walk; I want her to be
independent (9)."
Shortly after Breanna's birth Trellis
had been informed by her doctor that
Breanna would never walk; now she is
very capable of walking, and it's due
to this program (9).
Cerebral Palsy often will not hinder
a child from attending school, making
friends, or doing things they enjoy;
however, they will need assistance to
accomplish these things, with some requiring
more help than others. Computers and
wheelchairs are great tools to help
with communication and movement, but
more than anything children with CP
want to fit in just like other kids
their age. This can happen if more people
have knowledge of CP and the therapies
that can greatly advance a child's quality
of life. People need to understand that
CP largely affects motor skills, often
leaving children with high potential
to grow intellectually. The virtue of
patience is crucial when establishing
a bond with a child who has CP. The
bond formed will be greatly appreciated
and exponentially beneficial for both
of you (1).
references
- Bachrach, Steven, MD. (2003). Cerebral
palsy. Kid’s health for kids.
Retrieved September 27, 2005, From
http://www.kidshealth.org/kid/health_problems/brain/cerebral_palsy.html
- Bright tots: cerebral palsy.
(n.d.). Retrieved September 27, 2005,
From http://brighttots.com/Cerebral_Palsy.html.
- Cerebral palsy treatment.
Retrieved September 27, 2005, From
http://www.cerebralpalsyfyi.com/cp_therapy_and_treatment.html.
- Cerebral palsy types. (2000).
Retrieved September 27, 2005, From
http://www.cerebralpalsyfyi.com/cerebral_palsy_types.html.
- Children with cerebral palsy.
Retrieved September 27, 2005, From
http://www.indianchild.com/CerebralPalsy/spastic-cerebral-palsy.htm
- March
of dimes cerebral palsy.
(2005). Retrieved September 27, 2005,
From
http://www.marchofdimes.com/professionals/681_1208.asp
(outdated 01/28/08).
- National center on birth defects
and developmental disabilities, cerebral
palsy. (2004) Retrieved September
27, 2005, From
http://www.cdc.gov/ncbddd/dd/ddcp.htm
- Stopka, C. (3rd ed.).(1997). Applied
special physical education and exercise
therapy (pp. 3-6, 38). Boston,
MA: Pearson.
- Whinnery, K. W., & Barnes, S.
(2002). Mobility training using the
MOVE curriculum. Teaching Exceptional
Children, 34(3), 44-50.
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