Cerebral palsy also called CP refers to a group of disorders caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles resulting in an inability to move and maintain balance and posture.
Cerebral Palsy’s symptoms vary from person to person. While a person with severe Cerebral Palsy might not be able to walk at all or need to use special equipment to be able to walk, a person with mild CP might walk a little awkwardly. However, Cerebral palsy does not get worse over time, even though the exact symptoms may change as the person gets older.
Even though all people with CP have problems with movement and posture, many also develop related conditions as a result of the uncoordinated movement of the muscles. These conditions include epilepsy, problems with vision, hearing, or speech, intellectual disability; changes in the spine (scoliosis and others); joint problems (such as contractures); and seizures.
There are four main types of Cerebral Palsy. These are categorized according to types of movement disorders experienced by the persons as caused by the areas of the brain that are affected.
– Spastic Cerebral Palsy, which is the most common as it affects about 80 per cent of people with Cerebral Palsy. People with this disorder have stiff muscles which make their movements difficult. Spastic CP is described by what parts of the body are affected:
a) Spastic diplegia/diparesis, which is manifested by muscle stiffness mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking as the hip and leg muscles tightness might cause their legs to pull together, turn inward, and cross at the knees (scissoring).
b) Spastic hemiplegia/hemiparesis, this affects only one side of a person’s body with the arm usually more affected than the leg.
c) Spastic quadriplegia/quadriparesis, ―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.
– Dyskinetic Cerebral Palsy manifest with problems of controlling the movement of the hands, arms, feet, and legs, making it difficult to sit and walk. The muscles movements are uncontrollable: slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change from too tight to too loose from day to day or even during a single day. Dyskinetic Cerebral Palsy includes athetoid, choreoathetoid, and dystonic cerebral palsies.
– Ataxic Cerebral Palsy comes with problems of balancing and coordination. People with Ataxic Cerebral Palsy might be unsteady when they walk: having difficulty with quick movements or movements that need a lot of control, like writing. They might also have a hard time gripping or taking up something.
– Mixed Cerebral Palsy: this manifest with symptoms of more than one type of Cerebral Palsy. The most common type of mixed CP is spastic-dyskinetic Cerebral Palsy.
People with cerebral palsy experience uncontrolled or unpredictable muscles movements resulting in shaky movements or tremors while those with severe disorders have difficulties with head and neck control, bladder and bowel control, swallowing, breathing, eating and have dental and digestive problems.
Hence, children with Cerebral Palsy usually have mobility issues: unable to walk and sit independently at 2 years of age. They might also not be able to talk, have severe vision impairment, experience pains, have epilepsy, intellectual disability, and vision impairment.
Cerebral Palsy and Learning
Almost half of the people with Cerebral Palsy have an intellectual disability from a moderate to severe level. The intellectual disability is affected by the level of the person’s physical impairment. However, there are people with a high level of physical impairment but do not have an intellectual disability. Likewise, some might have a mild physical impairment but do have an intellectual disability.
Also, children with Cerebral Palsy may experience specific learning difficulties including short attention span, organisation and sequencing of movement, perceptual difficulties and language difficulties. These will greatly impact literacy, numeracy and other classroom skills and activities. To make learning more effective for children with Cerebral Palsy need to be encouraged to put more effort into concentrating on their movements and sequence of actions to avoid tiring more easily.
Children with cerebral palsy also have difficulty in learning because of some level of hearing impairment and vision impairment associated with Cerebral Palsy. Children with the more severe forms of CP are more likely to be deaf, experience myopia, absence of binocular fusion, ‘turned or ‘squint eye’, severe gaze dysfunction, and optic neuropathy or cerebral visual impairment. Some might even be blind.
Behavioural and emotional problems like being hyperactive, anxious, having difficulties with peers and even being prone to depression and anxiety disorders might also come with Cerebral Palsy.
Parents and teachers need to know that though learning difficulties in children with Cerebral Palsy are not directly related to the disorder but are associative conditions caused by additional damage to the developing brain. However, the severity of the disorder is primarily linked to the amount of damage to the brain. Studies have shown that learning difficulties in children with learning disorders are largely due to poor connectivity between neural pathways in the brain as children with cerebral palsy and a learning disorder still have cognitive functioning and are very much capable of learning, sensing, and reasoning. However, depending on the strength of connectivity within the brain, they may require more time and effort to process and learn new skills.
Teachers and parents should try to identify signs of learning disability in children with Cerebral Palsy early in the child so as to help in its management for the learning exercise in school.
However, learning disabilities might not be totally manifest until the child gets older. But early signs of a learning disability in children with cerebral palsy can include: delayed language skills, difficulties in communicating or understanding others, problems with following directions, difficulty with reading, writing, speaking, spelling, or counting
A paediatrician at a Teaching Hospital in Lagos told The Educational Tide that early detection of the disorder helps the child to settle down in life as professionals and the parents can work out a disorder management course for the child, including the schooling options that will help the child to interact with others and cope better for the activities required of him/her.
To help a child to cope better the efforts should be in the areas of speech, occupational, behavioural therapy.
Effective speech therapy involves improving the child’s communication skills by developing oral motor skills and the use of language. This can include teaching the use of sign language to make up for the loss of speech; augmentative and alternative communication; and trying to correct some difficulties with organization, focus and planning.
The purpose of occupational therapy is to improve the child’s fine motor skills to function well with the finger movements as well as develop higher-level cognitive skills, such as problem-solving and following multi-step directions.
Behavioural therapy helps the child manage emotional problems that arise from learning difficulties by developing coping strategies instead of showing frustration or anger.
Sadly, the paediatrician at a Teaching Hospital said these processes as a full complimentary package are not readily available for the Nigerian child. “It is a pity that the full complementary therapy needed by a Nigerian child with Cerebral Palsy is not readily available. Readily available in terms of the quality needed to make the process effective or in terms of being available at the right time needed. Even though, hundreds of thousands of cases of CP are being treated every year in Nigeria, governments have not deemed it fit to pay serious attention to the disorder for its proper management,” she said. Also, for a child with Cerebral Palsy special education will help prepare the child for proper schooling and learning. This process also includes adapting the general education curriculum to the child’s specific needs.
The therapies and the special education will help the child to improve in cognitive functions by consistent practice using the cognitive skills to make the brains adapt to learn at a quicker pace. These can be done through series of activities and tasks during the therapy sessions and at home.
For the special education teacher and the parents, the learning process must be handled with personalized attention and patience with the child’s unique strengths and weaknesses taken into consideration.
The learning process can better be done in shorter sessions but with enough time for the child to finish his/her work. As a child with a learning disability can take longer to process information and respond, tasks should be given in small pieces to enable him/her to have enough time to finish.
Set realistic expectations so that both the teacher, parents and child are not frustrated with the outcomes.
Make room for regular feedback from the child on how he/she feels about a certain task, topic or activity in terms of ease or difficulty in accomplishment.
Provide a creative environment for learning to leverage the child’s cognitive strengths and weaknesses. Pictures and other visual materials can be used if the child responds well to visual stimulation. Music and sound can also be so employed.
Make the child active during the learning process, this will help to improve the child improve his/her cognitive functioning.