Cerebral Palsy

Erin Goodridge
&
Amanda Yoho

Cause of Cerebral Palsy (CP)

Cerebral palsy is caused by brain injury or brain
malformation that occurs before, during, or
immediately after birth while the infants brain is
under development.

(MyChild at CerebralPalsy.org, 2015)

Types of Cerebral Palsy

Congenital CP is brain damage the happens before or during birth. The
majority of CP cases are congenital with the rate of being 85 - 90%.

Acquired CP the other 5 -10% of CP cases and is caused by brain

damage that occurs more than 28 days after birth.

Center for Disease Control and Prevention. (2015, July).

Biological Factors
Prenatal disturbance of brain cell migration genetic and environmental factors
disturb brain cell migration as cells move to their appropriate location during brain
development.
Prenatal poor myelination (insulation) of developing nerve cell fibers brain
function is impeded when poor myelin provides an inadequate protective covering over
nerve cells that aid in the transmission.
Perinatal brain cell death events in the birthing process that rupture blood vessels or
starve oxygen to the brain.
Postnatal non-functional or inappropriate connections (synapses) between brain
cells trauma, infections, and asphyxia that damage connections developed in the brain.
(MyChild at CerebralPalsy.org, 2015)

Environmental Factors
Congenital (Biological)
Low birthweightChildren who weigh less than 5 1/2 pounds (2,500 grams) at birth, and
especially those who weigh less than 3 pounds, 5 ounces
Premature birthChildren who were born before the 37th week of pregnancy, especially
if they were born before the 32nd week of pregnancy
Multiple birthsTwins, triplets, and other multiple births have a higher risk for CP,
especially if a babys twin or triplet dies before birth or shortly after birth.
Jaundice - happens when a chemical called bilirubin builds up in the babys blood.
Infections during pregnancy
Center for Disease Control and Prevention. (2015, July).

Environmental Factors
Acquired
InfectionInfections of the brain, for example, or encephalitis during infancy.
InjuriesInjuries to the brain, for example, head injuries caused by motor vehicle crashes
or child abuse.
Problem with blood flow to the brainCerebrovascular accidents, for example, stroke
or bleeding in the brain associated with a blood clotting problem, blood vessels that
didnt form properly, a heart defect that was present at birth, or sickle cell
Center for Disease Control and Prevention. (2015, July).

Red Flags
Babies
Low muscle tone (baby feels floppy when picked up)
Unable to hold up its own head while lying on their stomach or in a supported sitting
position
Muscle spasms or feeling stif
Poor muscle control, reflexes and posture
Delayed development (cant sit up or independently roll over by 6 months)
Feeding or swallowing difficulties
Preference to use one side of their body
Toddlers/Children
not walking by 12-18 months
not speaking simple sentences by 24 months
Cerebral Palsy Alliance. (2015).

Age and Onset of Symptoms

After birth - this can be determined if they child is having trouble with
feeding due to low muscle tone or if the child inability to use the suck,
swallow breathe method.
2 months - 18 months - child is not able to hold head up, roll over, sit
without support, crawl, pull to stand and walk.
18 months - 24 months - child still has gross and fine motor difficulty
along with a speech delay
Cerebral Palsy Alliance. (2015).

Characteristics of CP: Speech

Mild to Severe:

Communication Function Classification System this tool is used to

classify the everyday communication of an individual with cerebral palsy.
1. Effective Sender and Receiver with unfamiliar and familiar partners. The person
independently alternates between sender and receiver roles with most people in most environments.
The communication occurs easily and at a comfortable pace with both unfamiliar and familiar
conversational partners.
2. Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.
The person independently alternates between sender and receiver roles with most people in most
environments, but the conversational pace is slow and may make the communication interaction more
difficult.
3. Effective Sender and Receiver with familiar partners. The person alternates between sender
and receiver roles with familiar (but not unfamiliar) conversational partners in most environments.
4. Inconsistent Sender and/or Receiver with familiar partners. The person does not consistently
alternate sender and receiver roles.
5.

Seldom Effective Sender and Receiver even with familiar partners. The person is limited as
both a sender and a receiver. The persons communication is difficult for most people to understand.
Communication is seldom efective even with familiar partners.

Characteristics of CP: Gross Motor

Mild to Severe: Gross Motor Function Classification System
Level I
Can walk indoors and outdoors and climb stairs without using hands for support
Can perform usual activities such as running and jumping
Has decreased speed, balance and coordination.
Level II
Has the ability to walk indoors and outdoors and climb stairs with a railing
Has difficulty with uneven surfaces, inclines or in crowds
Has only minimal ability to run or jump.
Level III
Walks with assistive mobility devices indoors and outdoors on level surfaces
May be able to climb stairs using a railing
May propel a manual wheelchair (may require assistance for long distances or uneven
surfaces).
Cerebral Palsy Alliance. (2015)

Characteristics of CP: Gross Motor

Mild to Severe: Gross Motor Function Classification System
Level IV
Walking ability severely limited even with assistive devices
Uses wheelchairs most of the time and may propel their own power wheelchair
May participate in standing transfers.
Level V
Has physical impairments that restrict voluntary control of movement and the ability to
maintain head and neck position against gravity
Is impaired in all areas of motor function
Cannot sit or stand independently, even with adaptive equipment
Cannot independently walk, though may be able to use powered mobility.
Cerebral Palsy Alliance. (2015)

Characteristics of CP: Fine Motor

Mild to Severe: Manual Ability Classification System (used for children 4 -18 years of age).
1. Handles objects easily and successfully. At most, limitations in the ease of
performing manual tasks requiring speed and accuracy.
2. Handles most objects but with somewhat reduced quality and/or speed of
achievement Certain activities may be avoided or be achieved with some difficulty;
3. Handles objects with difficulty; needs help to prepare and/or modify activities
The performance is slow and achieved with limited success regarding quality and
quantity.
4. Handles a limited selection of easily managed objects in adapted situations
Performs parts of activities with efort and with limited success. Requires continuous
support and assistance and/or adapted equipment.
5. Does not handle objects and has severely limited ability to perform even
simple actions. Requires total assistance
Cerebral Palsy Alliance. (2015)

History of Cerebral Palsy

William John Little (1810-1894)
First to study and attempt to define spastic cerebral palsy.
Little sufered from several diseases as a young child including mumps, measles, and polio
which left him with a clubfoot. As he grew older, the causes of his impairment turned
into an interest for him. He decided to study medicine and became a doctor at age 27.
In the 1830s, Little began to lecture on birth injuries. This would be the beginning of his
work with cerebral palsy (unnamed at this time).
He published a paper in 1853 titled On the Nature and Treatment of the Deformities of the
Human Frame, which further developed his ideas.
In 1861 Little gave his first attempt at giving a name to spastic cerebral palsy. Little stated
that abnormal forms of labor, in which the child has been partially sufocated would
cause damage to the nervous system.
Littles contribution to the study of cerebral palsy was so significant that
it was first known as Littles Disease.
(MyChild at CerebralPalsy.org, 2015)

History of Cerebral Palsy

Sir William Osler (1849-1928)
Wrote first book about cerebral palsy and coined the name for cerebral palsy.
In addition to giving cerebral palsy the name we know it as today, Osler studied more
forms of the impairment than anyone before him.
The Cerebral Palsies of Children was the title of Oslers book, which explored the other
types of cerebral palsy and served as the framework for many of his lectures.

Sigmund Freud (1865-1939)

First to group a wide range of motor impairments.
Dr. Freud was a neurologist and believed that cerebral palsy was caused by abnormal
development in utero.
He was the first person to group a range of infantile impairments, which were
caused by atypical development of the brain. He called this abnormality
infantile cerebral palsy, which is still a relevant term today.
(MyChild at CerebralPalsy.org, 2015)

Educational Implications
Early Intervention
Services for children with CP age birth to 3 are imperative. As we know, this is these are
the ages in which children develop the most. Addressing a child with CPs needs early
on can drastically improve their symptoms.
Early intervention can help children and parents overcome challenges in daily routines.
Early intervention for a child with CP may include and early intervention specialist, speech
language pathologist, physical therapist, and/or occupational therapist.
Children may be introduced to certain types of adaptive equipment during early
intervention. These types of equipment could include leg braces, wheelchairs, walkers,
or communication devices.
(Head Start Center for Inclusion, n.d.)

Educational Implications
https://www.youtube.com/watch?v=hfMkcgmY4kA
This video shows the benefits of early intervention for children with
cerebral palsy.

Educational Implications

Eye tracking, a fairly new technology, makes use of the iris to give
commands to a computer system that in turn speaks for the user. The technology
provides a voice to people that previously had little way to express his or her
thoughts. Eye tracking is also used to create actions, such as the ones used to
operate a wheelchair without the use of limbs.
(MyChild at CerebralPalsy.org, 2015)

Educational Implications

Leg Braces
Walker
Wheelchair

Educational Implications
School Age
Once a child reaches the age of three, they will transition from early intervention to
preschool.
Teachers that are working with children with cerebral palsy need to be aware of how they
set up the classroom environment. Depending on the type of equipment being used
diferent arrangements may need to be made to ensure an accessible classroom
environment. This would include making sure there is enough space for any equipment
to easily navigate through as well as placing items within a childs reach.
Further learning with adaptive equipment may be needed throughout school, especially for
those students using a communication device.
Modifications to lesson plans need to be made so that all children can be included in
classroom activities. Due to the fact that cerebral palsy looks very diferent case to
case,
these modifications will also look very diferent.
(Head Start Center for Inclusion, n.d.)

Educational Implications
School Age
Accommodations or modifications will be identified on a childs IEP.
If a child with cerebral palsy is going to be included in a regular education classroom, it
might be necessary for an paraprofessional to stay with the student throughout the
day.
Teachers need to have a clear understanding of what the childs needs are so they are
able to refine their own expectations.
Children with CP might have a delayed time for response to questions. Teachers need to
make sure they give appropriate wait time.
Children with CP need to have their bodies positioned in a variety of ways in order to keep
their muscles from getting stif. Either the paraprofessional or the teacher would be in
charge of making sure this happens.
Teachers and paraprofessionals must work to keep good communication
with families to best meet the childs needs.
(Zachry, A., 2002)

Resources
Abilitycampinc. (2012, October 12). Teaching parents and tots with cerebral palsy [Video
file]. Retrieved from
https://www.youtube.com/watch?v=hfMkcgmY4kA
Center for Disease Control and Prevention. (2015, July). Causes and risk factors of cerebral
palsy. Retrieved from
http://www.cdc.gov/ncbddd/cp/causes.html
Cerebral Palsy Alliance. (2015). Signs and Symptoms of Cerebral Palsy. Retrieved from
https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptoms-of-cp
Cerebral Palsy Alliance. (2015).Severity of Cerebral Palsy. Retrieved from
https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/severity-of-cerebral-palsy/

Resources
Head Start Center for Inclusion. (n.d.) Children with special needs:Cerebral palsy. Retrieved from
http://depts.washington.edu/hscenter/sites/default/files/03_resources/08_childen_special_needs/docum
ents/cerebral_palsy.pdf
MyChild at CerebralPalsy.org. (2015). Eye tracking communication for individuals that are non-verbal.
Retrieved from
http://cerebralpalsy.org/inspiration/technology/eye-tracking/
MyChild at CerebralPalsy.org. (2015). Cerebral palsy pioneers. Retrieved from
http://cerebralpalsy.org/about-cerebral-palsy/history-and-origin/pioneers/
Zachry, A. (2002, January). Education techniques to help children with cerebral palsy in the classroom.
Retrieved from
http://www.brighthubeducation.com/special-ed-inclusion-strategies/43536-inclusive-teaching-strategiesfor-students-with-cerebral-palsy/