I.

THE PROBLEM

INTRODUCTION

What is the definition of cerebral palsy? Cerebral palsy is a term used to describe a group of chronic conditions affecting body movements and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development or infancy. It also can occur before, during or shortly following birth. "Cerebral" refers to the brain and "Palsy" to a disorder of movement or posture. If someone has cerebral palsy it means that because of an injury to their brain (cerebral) they are not able to use some of the muscles in their body in the normal way (palsy). Children with cerebral palsy may not be able to walk, talk, eat or play in the same ways as most other children.

Cerebral palsy is neither progressive nor communicable. It is also not "curable" in the accepted sense, although education, therapy and applied technology can help persons with cerebral palsy lead productive lives. It is important to know that cerebral palsy is not a disease or illness. It isn't contagious and it doesn't get worse.

Children who have cerebral palsy will have it all their lives.

Cerebral palsy is characterized by an inability to fully control motor function, particularly muscle control and coordination. Depending on which areas of the brain have been damaged, people with cerebral palsy may experience one or more of the following:

y y y y y y

Nuscle tightness or spasm Involuntary movement Disturbance in gait and mobility Abnormal sensation and perception Impairment of sight, hearing or speech Seizures

Cerebral Palsy Diagnosis

How is the diagnosis of cerebral palsy made? When an infant or child has brain damage, a variety of symptoms can lead doctors and parents to suspect that something is wrong. In the first few months of life, an infant with brain damage may demonstrate some or all of the following symptoms that can indicate cerebral palsy: Lethargy, or lack of alertness Irritability or fussiness Abnormal, high-pitched cry
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y y y

y y

Trembling of the arms and legs Poor feeding abilities secondary to problems sucking and swallowing

y y y y

Low muscle tone Abnormal posture, such as the child favoring one side of the body Seizures, staring spells, eye fluttering, body twitching Abnormal reflexes.

During the first six months of life, other signs of brain injury suggestive of cerebral palsy also may appear in an infantsmuscle tone and posture. These signs include: Muscle tone may change gradually from low tone to high tone; a baby may go from floppy to very stiff.
y y

The child may hold his or her hand in tight fists. There may be asymmetries of movement, that is, one side of the body may move more easily and freely than the other side.

The infant may feed poorly, with their tongue pushing food out of their mouth forcefully.

Once a baby with brain damage reaches six months of age, it usually becomes quite apparent that he or she is picking up movement skills slower than normal. Infants with cerebral palsy are more often slow to

reach certain developmental milestones, such as rolling over, sitting up, crawling, walking and talking. Parents are more likely to

notice developmental delays, abnormal behaviors, and signs of cerebral palsy, especially if this is not their first child. Sometimes when they express their concerns to their physicians, their child is immediately diagnosed as having cerebral palsy. More often, however, medical professionals hesitate to use the term "cerebral palsy"at first. Instead, they may use broader terms such as: Developmental delay, which means that a child is slower than normal to develop movement skills such as rolling over and sitting up
y

Neuromotor dysfunction, or delay in the maturation of the nervous system.

y y

Motor disability, indicating a long term movement problem Central nervous system dysfunction, which is a general term to indicate the brain's improper functioning

Static encephalopathy, meaning abnormal brain function that is not getting worse. So why do doctors frequently delay making a final diagnosis

and prognosis when a child may have cerebral palsy? Part of the answer lies in the plasticity of a child's central nervous system, or it's
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ability to recover completely or partially after an injury occurs. The brains of very young children have a much greater capacity to repair themselves than do adult brains. If a brain injury occurs early, the undamaged areas of a child's brain can sometimes take over some of the functions of the damaged areas. Although the child may have some motor impairment, he or she can often make great progress in other motor skills.

Another reason doctors may delay a diagnosis of cerebral palsy is that a child's nervous system organizes over time. Damage to the brain may affect your child's motor abilities differently. For example, tone can go from low to high or vice versa, or involuntary movements can become more obvious. Generally, however, a child's motor symptoms stabilize by two to three years of age. After this age, tone is probably not going to change dramatically.

So what does all of this mean? It means that a cerebral palsy diagnosis is not made over night. Since the extent of your child's problems will probably not be clear for some time, his or her symptoms need to be monitored by an interdisciplinary team. This is a group of professionals with specialties in different areas. These health care professionals gather
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information

on

the

child's

accomplishments and make comparisons over the months and years of the child's life. They will keep you up to date on your child's current needs and problems, as well as the medical reasons for these problems, if known. When diagnosing cerebral palsy, the

interdisciplinary team must first conduct an assessment, or evaluation of the child's strengths and needs in all areas. As your child grows older, additional assessments may be necessary.

In conclusion, cerebral palsy is diagnosed by a complete examination of your child's current health status. Doctors will test your child's motor skills and look carefully at his or her medical history. They will also look for slow development, abnormal muscle tone, and unusual posture. When diagnosing cerebral palsy, doctors must rule out other disorders that can cause abnormal

movements. Cerebral palsy does not get worse. In other words, it is not progressive. Based on this fact, doctors must make the determination that your child's condition is not progressively getting worse. Doctors will also use a number of different specialized tests in diagnosing cerebral palsy. For example, the doctor may order a CT (computed tomography). This is an imaging of the brain that can determine underdeveloped areas of brain tissue. The doctor may also order an MRI (magnetic resonance imaging). This test also generates
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a picture of the brain to determine areas that may be damaged. In addition to these imaging tests, intelligence testing is also used. This helps to determine if a child is behind from a mental standpoint. In addition to diagnosing cerebral palsy through a complete and thorough examination of the child's abnormalities and behaviors, a review of the mother's pregnancy, labor and delivery and care received is also conducted.

PURPOSE OF THE STUDY

Raising Awareness on Cerebral Palsy Dina (an alias) experienced difficulties when delivering her first baby at a hospital in her hometown. As the baby would not come out, the attending doctor decided to use a vacuum to extract it. However, the umbilical cord had become wrapped around the baby's neck in her uterus, and during the procedure his oxygen supply was cut off.

When the baby was finally born, he didn't cry and his body was convulsing. He had gone into a coma from oxygen deprivation and needed to be placed in intensive care for a month following birth. Later, it was found that his brain had been infected with cytomegalovirus, a type of herpes virus that Dina might have contracted during pregnancy.

Now 4.5 years old, Rangga (alias) has quadriplegic cerebral palsy. Dina diligently brings her son for therapy at Keanna, a private rehabilitation center in Cilandak, South Jakarta. His prognosis is not good, as he cannot move any part of his body, not even his eyes. But Dina is an optimist. "There is progress," she told The Jakarta Post, adding that she was ecstatic when Rangga finally smiled for the first time at her touch.

Cerebral palsy (CP) is a physical disorder resulting from non-genetic factors that cause brain damage, such as oxygen deprivation, infection and physical trauma, during or after pregnancy.

"The brain damage itself is non-progressive, but it can cause physical disorders," said pediatric neurologist Dr. Irawan Mangunatmadja of Cipto Mangunkusumo General Hospital in North Jakarta.

"It is a persistent, but not unchanging, disorder of movement and posture appearing in the early years of life," he said.

Several viruses can cause in utero brain damage such as TORCH, which stands for toxoplasma, rubella, cytomegalovirus (CMV) and herpes simplex virus II (HSV-II).

Toxoplasma is a genus of parasitic protozoa whose best host are cats; however, the vast majority of warm-blooded animals can carry it. The disease it causes, toxoplasmosis, can have fatal effects on a fetus during pregnancy.

The rubella virus causes rubella, or German measles. The virus is hard to detect, as it usually exhibits only mild symptoms or is asymptomatic.

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Cytomegalovirus (CMV) is an ordinary virus and hardly ever causes noticeable disease, but it belongs to the herpes family, while HSV-II causes excruciating sores on the anus or genitals and may be dormant in nerve tissues.

Oxygen deprivation and a lack of nutrition channeled from the placenta to the fetus are also cited as possible causes of brain damage in the uterus; these also can cause low birth weight, viral encephalitis, brain tumors, head injuries and meningitis after birth.

"Generally, cerebral palsy can be categorized by the tonus, or muscle rigidity, and areas of the affected body," said Irawan.

CP is mainly classified according to tonus into three types: spastic CP, athetoid CP and ataxic CP.

Spastic CP is regarded as the most common form, wherein the cerebral cortex -- the region of the brain that controls thought movement and sensation -- is damaged. In such cases, the arms are usually hang lifeless, and the hands are twisted against the forearm. Its effects on the legs can be noticed by the way the child walks, depending on the degree of severity.

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Athetoid CP results in involuntary, uncontrolled and uncoordinated movements of the muscles, due to damage of the basal ganglion. Consequently, all limbs display jerky movements while the fingers and wrists are twisted. Due to poor coordination, the child might also stumble when walking.

Ataxic CP is the rarest of the three and results from damage to the cerebellum, which controls stability. A child with this type of CP will have difficulties with balance.

According to the affected areas of the body, CP is classified into hemiplegic CP, diplegic CP and quadriplegic CP.

Hemiplegic CP describes the condition when half of the body -- such as the right arm and right leg, or the left arm and left leg -- is affected. Almost all children with this form CP are able to walk, since spasticity mostly affects the arm.

Diplegic CP is indicated by the more severely affected lower limbs, which is commonly found in babies born prematurely, while in quadriplegic CP, all four limbs are severely affected.

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Technology can help detect the degree of brain disorder through the computerized tomography (CT) scan or magnetic resonance imaging (MRI). The position emission tomography (PET) scan is used to identify any specific chemicals in the brain while the electroencephalogram (EEG) can also be useful in detecting brain disorders.

Children with CP are found in both developed and developing countries. In the 1970s and '80s, the number of children born with CP in developed countries declined, but appeared to rise after this period.

In the United States, CP occurs in 1.5 to four children per 1,000 live births; in Indonesia, about 2 percent of babies are born with delayed development, including cerebral palsy.

Various forms of rehabilitation can be helpful to children with CP, such as physical therapy, a standing frame to reduce spasticity, or the Bobath Concept to help the child physiologically through play to improve posture and reduce stiffness.

Aside from private rehabilitation centers in Jakarta, many hospitals, like Cipto Mangunkusumo General Hospital, Fatmawati General Hospital and Harapan Kita Hospital, have rehabilitation and treatment wards for children with delayed development.

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"But parents cannot depend merely on treatment here," said therapist Retno of Cipto Mangunkusumo. "We (also) give them exercises to be done at home."

While the child is encouraged to learn some skills, therapy is administered in stages.

"First, we have to relax their muscle rigidity through exercises before giving them functional exercises," said therapist Ahmad Syakib of Fatmawati hospital.

For example, he said, one patient with athetoid CP required exercises for coordination to treat involuntary movement.

"What we can do is to encourage them to be as independent as possible, since CP has no cure," said Ahmad.

As cerebral palsy is non-genetic, women with CP can still have healthy babies, and Ahmad gave as examples two adult female patients with CP who have normal and healthy children.

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Nevertheless, some factors still hamper the proper treatment and handling of children with CP.

Irawan lamented that many parents appeared to have a low awareness of the condition, and when they notice that their children have some kind of delayed development, they preferred to adopt "alternative" treatments -- until it was too late for a professionally designated rehabilitation program.

He added that the parents' financial situation could adversely impact CP therapy, and supporting public facilities remained almost nonexistent in Indonesia.

"What is also important is their chance to go to school, to have an education," added therapist Novi of Cipto Mangunkusumo hospital.

Children with cerebral palsy have various degrees of learning problems; the most common are visual impairment, hearing impairment and difficulties with speech and language. Some are good at mathematics and reading, but poor at perceiving shapes.

The average intelligence quotient of a child with CP is 100, with many registering in the 70-80 IQ range.

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But those with an IQ of 119 or above are usually able to excel in school, said psychologist Annie L. Perbowo of Harapan Kita hospital and the Pela 9 rehabilitation center.

The government has campaigned for sekolah inklusi (inclusive school), under which normal schools are to accept children with special needs. In 2003, 21 schools -- from kindergarten to high school, including vocational high schools -- across the five Jakarta districts participated in the program.

The campaign, however, is yet to be followed by concrete support from the government.

For example, the Post observed that a state elementary school in Bangka, South Jakarta, that accepts around five children with special needs every school year is not yet equipped with supporting facilities such as a special ramp and toilet. The school also has to arrange a special education teacher on its own.

It appears that no minimal standardization of school infrastructure and teaching staff exists for special needs children, such as those with cerebral palsy.

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Further, several teachers at different schools did not have any understanding of cerebral palsy, merely grouping CP children among others with mental retardation or hearing and visual impairment.

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STATEMENT OF THE PROBLEM

Effect of Cerebral Palsy on Childs Development Children with cerebral palsy (CP) have problems with muscle tone, balance and motor skills. CP is caused by brain damage during development. CP is actually an umbrella term that describes several disorders. Depending on the area of the brain that is damaged and the extent of the injury, different symptoms can result. According to the Merck Medical Manual, CP affects 2 to 4 out of every 1,000 children born in the United States.

Muscle and Tendon Stiffness

CP is strongly associated with muscle and tendon stiffness, either on one side of the body or both. This is true for all three major types of CP: spastic hemiplegia (SH), spastic diplegia (SD) and spastic quadriplegia (SQ). The tightness can interfere with the smoothness of all movements, especially walking.

Trouble Crawling and Walking Children with the SH and SD forms of CP will crawl and walk later than unaffected children. When children with SH do start to crawl, they often favor one side, tending to avoid using the arm and leg with which they have problems. When they eventually walk, CP children often exhibit a tip-toe gait to compensate
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for muscle stiffness and short tendons. The use of walkers and leg braces are often useful for addressing these symptoms. Children with SQ, however, will typically never be able to walk.

General Delay in Reaching Developmental Milestones

The earliest indicator that a child has CP is a delay in achieving standard developmental milestones. Most children roll over by 4 months, sit independently by 5 months and crawl by 7 months of age. Parents may wish to consult a pediatrician if their child misses these milestones by more than several months.

Poor Manual Coordination

In addition to problems with gross motor function, children with CP tend to have difficulty controlling their arms and hands. Performing actions that require precise control such as pouring liquid from one container to another is very difficult. Children with SH have trouble with the arm on one side; children with DH have trouble with both.

Speech Difficulties

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CP interferes with controlling muscles, including those of the face and tongue. As a result, speech problems are strongly associated with CP. Children with SH and SD both start talking later and have difficulty with pronunciation and being understood. Children with the severe SQ form of CP are typically never able to speak. It should be noted that, in many cases, children with CP have normal intelligence. The inability to speak may be completely due to problems with muscle coordination. Assistive technologies that enable children with CP to communicate via other means have been very useful in overcoming this particular set of problems.

Lack of Muscle Tone

While some muscles of children with CP may be too tight and inflexible, other muscles may be too loose, exhibiting too little tone and activation when needed. For instance, children with the SQ form of CP typically have a loose and poorly controlled neck, resulting in floppy head movements.

Lack of Facial Control

A child with CP will often exhibit uncontrollable spastic contractions of the facial muscles, producing a grimace expression. The control of the lips and tongue can also be problematic, resulting in drooling.

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Seizures

For children with the severe SQ form of CP, seizures are common. The severity and duration are highly variable. Seizures during early infancy are an early indicator that a child may have CP.

Curvature of the Spine (Scoliosis)

As children with the SH form of CP favor one side of the body to walk and balance, a curvature of the spine can develop. This is referred to as scoliosis.

Writhing Movements of the Hands and Feet

A less common form of CP is dyskinetic cerebral palsy (DCP). In addition to other CP symptoms, children with DCP tend to make uncontrollable writhing movements of the hands and feet.

Object Grasping Tremor

Ataxic cerebral palsy (ACP) is a rare form of CP associated with many of its typical symptoms. ACP is different, however, in that some of the symptoms, such

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as muscle tremors, greatly increase in severity when reaching to grasp a target object.

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Scope of the study

Cerebral palsy (CP) is divided into four major classifications to describe different movement impairments. These classifications also reflect the areas of the brain that are damaged. The four major classifications are: spastic, ataxic, athetoid/dyskinetic and mixed.

Spastic Spastic cerebral palsy is by far the most common type of overall cerebral palsy, occurring in 80% of all cases.[11] People with this type of CP are hypertonic and have what is essentially a neuromuscular mobility

impairment (rather than hypotonia or paralysis) stemming from an upper motor neuron lesion in the brain as well as the corticospinal tract or the motor cortex. This damage impairs the ability of some nerve receptors in the spine to properly receive gamma amino butyric acid, leading to hypertonia in the muscles signaled by those damaged nerves.

As compared to other types of CP, and especially as compared to hypotonic or paralytic mobility disabilities, spastic CP is typically more easily manageable by the person affected, and medical treatment can be pursued on a multitude of orthopedic and neurological fronts throughout life. Spastic CP is

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classified by topography dependent on the region of the body affected; these include:

Spastic hemiplegia is one side being affected. Generally, injury to musclenerves controlled by the brain's left side will cause a right body deficit, and vice versa. Typically, people that have spastic hemiplegia are the most ambulatory of all the forms, although they generally have dynamic equinus (a limping instability) on the affected side and are primarily prescribed ankle-foot orthoses to prevent said equinus.

Spastic diplegia is the lower extremities affected, with little to no upper-body spasticity. The most common form of the spastic forms (70-80% of known cases), most people with spastic diplegia are fully ambulatory, but are "tight" and have a scissors gait. Flexed knees and hips to varying degrees, and moderate to severe adduction (stemming from tight adductor muscles and comparatively weak abductor muscles), are present. Gait analysis is often done in early life on a semi-regular basis, and assistive devices are often provided like walkers, crutches or canes; any ankle-foot orthotics provided usually go on both legs rather than just one. In addition, these individuals are often nearsighted. The intelligence of a person with spastic diplegia is unaffected by the condition. Over time, the effects of the spasticity sometimes produce hip problems and dislocations (see the main article and spasticity for more on spasticity effects). In three-quarters of spastic diplegics,

also strabismus (crossed eyes) can be present as well.

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Spastic monoplegia is one single limb being affected. Spastic triplegia is three limbs being affected. Spastic quadriplegia is all four limbs more or less equally affected. People with spastic quadriplegia are the least likely to be able to walk, or if they can, to desire to walk, because their muscles are too tight and it is too much of an effort to do so. Some children with spastic quadriplegia also have hemiparetic tremors, an uncontrollable shaking that affects the limbs on one side of the body and impairs normal movement.

Axatic

Ataxia type symptoms can be caused by damage to the cerebellum. The forms of ataxia are less common types of cerebral palsy, occurring in at most 10% of all cases. Some of these individuals have hypotonia and tremors. Motor skills such as writing, typing, or using scissors might be affected, as well as balance, especially while walking. It is common for individuals to have difficulty with visual and/or auditory processing.

Athetoid/Dyskinetic

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Athetoid cerebral palsy or dyskinetic cerebral palsy is mixed muscle tone both hypertonia and hypotonia mixed with involuntary motions. People with

Dyskinetic CP have trouble holding themselves in an upright, steady position for sitting or walking, and often show involuntary motions. For some people with dyskinetic CP, it takes a lot of work and concentration to get their hand to a certain spot (like scratching their nose or reaching for a cup). Because of their mixed tone and trouble keeping a position, they may not be able to hold onto objects, especially small ones requiring fine motor control (such as a toothbrush or pencil). About 10% of individuals with CP are classified as dyskinetic CP but some have mixed forms with spasticity and dyskinesia.[13] The damage occurs to the extrapyramidal motor system and/or pyramidal tractand to the basal ganglia. In newborn infants, high bilirubin levels in the blood, if left untreated, can lead to brain damage in in the basal ganglia (kernicterus), which can lead to dyskinetic cerebral palsy.

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DEFINITION OF TERMS

Seizures a sudden attack of an illness or condition speciall of the kind experienced by people with epilepsy.

Spasm a sudden brief emotion, sensation or action.

Atoxic the inability to coordinate the movement of the muscles.

Spastics offensive term meaning lacking physical.

Epilepsya medical siorder involving episode of irregular electrical discharges in the brain ang characterized by the periodic sudden loss or impairment of consciousness, often accompanied by convulsions

Toxins substance that accumulates at the body and causes it harm.

Paralysis loss of voluntary movement as a result of damage to nerve or muscle function.

Scoliosis curvature of the spine.

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II.

RELATED LITERATURE

RELATED STUDIES

Causes of Cerebral Palsy

Why does your child have cerebral palsy? The simplest answer to this question is because your child has brain damage. This leads naturally into the second question: Why does your child have brain damage? There are many possible answers to this second question, because there are many reasons children can sustain brain damage. Your doctor must carefully review your child's health history and conduct a variety of medical and neurological tests to help determine the cause. Cerebral palsy is caused by an injury to the brain before, during, or shortly after birth. In many cases, no one knows for sure what caused the brain injury or what may have been done to prevent the injury. A large number of factors which can injure the developing brain may produce cerebral palsy. In general, however, there are two problems that can cause cerebral palsy:

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1. Failure of the brain to develop properly (developmental brain malformation) 2. Neurological damage to the child's developing brain Whatever the cause of your child's cerebral palsy, the severity of the brain damage generally depends on the type and timing of the injury. For example, in very premature babies, bleeding into the brain

(intraventricular hemorrhage) can cause extensive damage. Also, the longer an unborn child goes without oxygen, the greater the extent of brain tissue damage.

Ten to fifteen percent of cerebral palsy is caused from a recognized brain injury, such as infection (like meningitis), bleeding into the brain, and damage caused by lack of oxygen. It is very important that you understand that a brain injury caused during delivery in many cases could have been prevented. Medical mistakes are responsible for thousands and thousands of cerebral palsy cases. It would be virtually impossible for a parent, on their own, to determine if a medical mistake caused their child's cerebral palsy or brain damage. It is only through the concerted efforts of a legal/medical team that can answer the question, "was my child's cerebral palsy preventable?"

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Pregnancy Risk Factors

y y y y y

Maternal diabetes or hyperthyroidism. Maternal high blood pressure. Poor maternal nutrition. Maternal seizures or mental retardation. Incompetent cervix (premature dilation) leading to premature delivery.

Maternal bleeding from placenta previa (a condition in which the placenta covers a portion of the cervix leads to bleeding as the cervix dilates) or abruptio placenta (premature separation of the placenta from the uterine wall)

Delivery Risk Factors

y y

Premature delivery (less than 37 weeks gestation) Prolonged rupture of the amniotic membranes for more than 24 hours leading to fetal infection

Severely depressed (slow) fetal heart rate during labor, indicating fetal distress

Abnormal presentation such as breech, face, or transverse lie, which makes for a difficult deliver
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Neonatal Risk Factors

Premature birth the earlier in gestation a baby is delivered, the more likely she is to have brain damage

Asphyxia insufficient oxygen to the brain due to breathing problems or poor blood flow in the brain.

y y

Meningitis infection over the surface of the brain Seizures caused by abnormal electrical activity of the brain Interventricular hemorrhage (I. V. H.) bleeding into the interior spaces of the brain or into the brain tissue

Periventricular encephalomalacia (P.V.L.) damage to the brain tissue located around the ventricles (fluid spaces) due to the lack of oxygen or problems with blood flow

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RELEVANCE OF THE SIGNIFICANT RESULTS

Cerebral Palsy : Leading a Normal Life

Here are a few conditions that are disheartening and tragic as cerebral palsy, but there is nothing more heartbreaking than a child struggling with the dreadful disease.

Cerebral palsy is a group of diverse conditions that cause varying levels of motor and sometimes mental dysfunction. Most children who suffer from cerebral palsy experience difficulty performing simple functions such as moving, speaking, and eating due to damaged nerves, tendons, muscles, and bones. There is also an increased chance of mental retardation in children who have cerebral palsy.

Unfortunately, there is no way to project whether or not a child will suffer from cerebral palsy. Even though there are certain controllable variables during early stages of pregnancy that can predict a possibility of cerebral palsy, most of the situations that may cause a child to develop this devastating and lifechanging condition occur just before or during childbirth. An experienced and vigilant obstetrician can address a large number of these problems. Nonetheless, a moments distraction, clumsiness, or hesitation can inflict a lifetime of misery on a child and their parents.

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On the other hand, with proper therapy, many people with cerebral palsy can still lead normal lives. Even those with very severe disabilities can improve their condition significantly, even though they will never be able to live independently.

Approximately 25% of children with cerebral palsy have mild involvement with few or no limitations inwalking, self-care, and other activities. Approximately half are moderately impaired to the extent that complete independence is unlikely but function is satisfactory. Only 25% are so severely disabled that they require extensive care and are unable to walk.

Of the 75% of children with cerebral palsy who are eventually able to walk, many rely on mobility equipment. The ability to sit unsupported may be a good predictor of whether or not a child will walk. Many children who can sit unsupported by age 2 years eventually get to walk, while those who cannot sit unsupported by age 4 years probably will not walk. These children will use wheelchairs to move around.

People with milder forms of cerebral palsy have the same life expectancy as the general population. Those with severe forms of cerebral palsy typically have a shorter life span, especially if they have many medical complications.

Some studies have found that abnormalities of muscle tone or movement in the first several weeks or months after birth may gradually improve over the first years of life. In one study, almost 50% of very young infants thought to have

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cerebral palsy and 66% of those thought to have spastic diplegia outgrew these signs of cerebral palsy by age 7 years. Many children do not manifest full motor signs that are suggestive of cerebral palsy until aged 1-2 years. Thus, some propose that the diagnosis of cerebral palsy should be deferred until the child is aged 2 years.

There are many cases of children with cerebral palsy who grow up to have a normal life. Although this is possible, it is surely not an easy feat. To bring positive change in the condition of children who have cerebral palsy, they would have to undergo several therapies and would also have to be given special attention in schools.

Every child with cerebral palsy may need a different kind of therapy, according to the severity of the disorder. Teaching and training a child with this disorder is not a single persons job. The major contributors in this case are the parents, who have to first cope with the fact that their child is different from others. It also includes the combined efforts of the physical therapist, doctors, special education teachers, and psychologists.

Physical therapists help children with cerebral palsy in developing simple motor skills. Physical therapy helps them in learning how to walk with their braces, as well as to stand and move around without help. They may also be taught to kick a ball and to ride a bicycle, provided the disability allows.

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In addition to this, enrolling children in special schools will also do well with their development. Teachers at special schools are trained to teach children with disabilities. Teachers of special children are expected to show great patience with such children. In special schools, every child is given individual attention and the curriculum is also planned so as to cater to their individual needs. All this helps to develop the childs abilities with a view to foster his independent / near independent functioning at a later stage.

Some children with cerebral palsy are capable of attending mainstream schools with normal children of their age. A teacher who has such child in her class need not change the whole curriculum, but needs to deal a little differently with the disabled child. One should understand that the child is not like the other kids and may take a little more time to understand or respond to what is happening in the class. However, they should not be treated very differently. These kids should not be judged only by their disability, but should be encouraged to think and participate in the activities of the class. It has been observed that children who attend regular schools from a very young age, show great improvement. It is also good for the other children in the class because this will develop feelings of compassion towards individuals who are different from them.

One very important thing to remember is that children with cerebral palsy may have a disability but that does not make them weak or incapable. Giving them training and teaching them skills to be independent from an early age would

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surely prove beneficial. One must keep in mind that children born with cerebral palsy are differently-abled kids, who have every right to live a normal and successful life.

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III.

METHODOLOGY

DESCRIPTION OF THE RESEARCH

Descriptive research What Is Descriptive Research?

Descriptive research does not fit neatly into the definition of either quantitative or qualitative research methodologies, but instead it can utilize elements of both, often within the same study. The term descriptive research refers to the type of research question, design, and data analysis that will be applied to a given topic. Descriptive statistics tell what is, while inferential statistics try to determine cause and effect.

The type of question asked by the researcher will ultimately determine the type of approach necessary to complete an accurate assessment of the topic at hand. Descriptive studies, primarily concerned with finding out "what is," might be applied to investigate the following questions: Do teachers hold favorable attitudes toward using computers in schools? What kinds of activities that involve technology occur in sixth-grade classrooms and how frequently do they occur? What have been the reactions of school administrators to technological

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innovations in teaching the social sciences? How have high school computing courses changed over the last 10 years? How do the new multimediated textbooks compare to the print-based textbooks? How are decisions being made about using Channel One in schools, and for those schools that choose to use it, how is Channel One being implemented? What is the best way to provide access to computer equipment in schools? How should instructional designers improve software design to make the software more appealing to students? To what degree are special-education teachers well versed concerning assistive technology? Is there a relationship between experience with multimedia computers and problem-solving skills? How successful is a certain satellitedelivered Spanish course in terms of motivational value and academic achievement? Do teachers actually implement technology in the way they perceive? How many people use the AECT gopher server, and what do they use if for?

Descriptive research can be either quantitative or qualitative. It can involve collections of quantitative information that can be tabulated along a continuum in numerical form, such as scores on a test or the number of times a person chooses to use a-certain feature of a multimedia program, or it can describe categories of information such as gender or patterns of interaction when using technology in a group situation. Descriptive research involves gathering data that describe events and then organizes, tabulates, depicts, and describes the data collection (Glass & Hopkins, 1984). It often uses visual aids such as graphs and
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charts to aid the reader in understanding the data distribution. Because the human mind cannot extract the full import of a large mass of raw data, descriptive statistics are very important in reducing the data to manageable form. When indepth, narrative descriptions of small numbers of cases are involved, the research uses description as a tool to organize data into patterns that emerge during analysis. Those patterns aid the mind in comprehending a qualitative study and its implications.

Most quantitative research falls into two areas: studies that describe events and studies aimed at discovering inferences or causal relationships. Descriptive studies are aimed at finding out "what is," so observational and survey methods are frequently used to collect descriptive data (Borg & Gall, 1989). Studies of this type might describe the current state of multimedia usage in schools or patterns of activity resulting from group work at the computer. An example of this is Cochenour, Hakes, and Neal's (1994) study of trends in compressed video applications with education and the private sector.

Descriptive studies report summary data such as measures of central tendency including the mean, median, mode, deviance from the mean, variation, percentage, and correlation between variables. Survey research commonly includes that type of measurement, but often goes beyond the descriptive statistics in order to draw inferences. See, for example, Signer's (1991) survey of computer-assisted instruction and at-risk students, or Nolan, McKinnon, and
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Soler's (1992) research on achieving equitable access to school computers. Thick, rich descriptions of phenomena can also emerge from qualitative studies, case studies, observational studies, interviews, and portfolio assessments. Robinson's (1994) case study of a televised news program in classrooms and Lee's (1994) case study about identifying values concerning school restructuring are excellent examples of case studies.

Descriptive research is unique in the number of variables employed. Like other types of research, descriptive research can include multiple variables for analysis, yet unlike other methods, it requires only one variable (Borg & Gall, 1989). For example, a descriptive study might employ methods of analyzing correlations between multiple variables by using tests such as Pearson's Product Moment correlation, regression, or multiple regression analysis. Good examples of this are the Knupfer and Hayes (1994) study about the effects of the Channel One broadcast on knowledge of current events, Manaev's (1991) study about mass media effectiveness, McKenna's (1993) study of the relationship between attributes of a radio program and its appeal to listeners, Orey and Nelson's (1994) examination of learner interactions with hypermedia environments, and Shapiro's (1991) study of memory and decision processes.

On the other hand, descriptive research might simply report the percentage summary on a single variable. Examples of this are the tally of reference citations in selected instructional design and technology journals by Anglin and Towers
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(1992); Barry's (1994) investigation of the controversy surrounding advertising and Channel One; Lu, Morlan, Lerchlorlarn, Lee, and Dike's (1993) investigation of the international utilization of media in education (1993); and Pettersson, Metallinos, Muffoletto, Shaw, and Takakuwa's (1993) analysis of the use of verbovisual information in teaching geography in various countries.

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DATA PROCESSING ANALYSIS

Life Expectancy of those who have Cerebral Palsy

The main sources of data for research on life expectancy in cerebral palsy are databases maintained by Professor Jane Hutton and her colleagues in the UK, and our California developmental disabilities database. In addition there are a few other studies from other countries/regions, such as Canadian study of Crichton and the Western Australian study of Blair.

The research suggests that when children with comparable disabilities are compared, the resulting prognoses for life expectancy are similar. This point has sometimes been misunderstood, because the California database is able to identify children with exceptionally severe patterns of disabilities (e.g., tube fed and unable to lift head when lying in prone) who have lower life expectancies than groups of children in other studies with less severe disabilities.

Some earlier studies had major methodological errors, and the results are
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therefore not to be relied on. The errors in Plioplys et al. are noted in Strauss et al. and explained here. The errors in the Eyman et al. studies are noted in Strauss et al. and explained here.

The first large study to give life expectancy (as opposed to survival curves) appears to be our 1998 study of life expectancy of adults with cerebral palsy. This has been updated and superseded by our more recent work. For convenience, the Table of life expectancies given there is reproduced below. Full details and technical discussion is given in the source article.

Older persons with cerebral palsy. The 2004 study by Strauss et al. appears to be the only published article that addresses life expectancy for older persons (age 60+) with cerebral palsy. As is usually the case, persons who are still fully ambulatory have life expectancies that are not dramatically shorter than normal, while those with more severe motor dysfunction have shorter ones.

Secular trend. There has been much discussion of whether longevity in cerebral palsy has improved over recent decades. Until recently, the studies that looked into this had reported finding no such trend. However, the 2007 Strauss et al. study found evidence for such a trend, though confined to persons with the most severe disabilities. This trend is taken into account in our most recent research.

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CONCLUSION AND RECOMMENDATION

CEREBRAL PALSY IS NOT A DEATH SENTENCE

Melia Benjamin

Cerebral Palsy is caused by lack of oxygen to the brain usually at or before birth due to a traumatic event. My cerebral palsy was caused by a fall my Mom incurred when she was about six months pregnant with me causing her to be hospitalized and put on complete bed rest until I was born a month or so later by cesarean section because the doctors and nurses could not detect a heartbeat (this was in 1971 before ultrasound and other technologies were invented) so they immediately scheduled the surgery. To everyones surprise I was alive and yes very small and sickly looking but I was a strong infant. The sad thing was the this same medical staff was telling my parents that they could not see or hold me and that I would probably not make it past the first day. This was before doctors actually learned that there are medical benefits to premature infants having human contact on a regular basis. Well I did without the kind touch of my mom or dad and as you can tell I lived past the first day and all the other initial predictions the staff came up with, at the time.

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In actuality I am lucky because I have a very slight case of cerebral palsy because only parts of the left hemisphere of my brain was effected, which thus caused my right motor skills to be damaged. The result is that I have little use of my right hand and walk with a limp. I am much better than any doctor ever thought I would ever amount to. My dad even taught me how to walk when I was two by way of a Mattel Toys: Tough Stuff Cart in the early seventies when he worked for the company and received test products to test on his own two daughters. He taped my right hand to the orange cart handle and put red bricks in the yellow basket portion and stood behind me encouraging me to take a step one after the other. Of course, my Mom was standing on our front porch crying her eyes out because she felt that my dad was hurting me when all along he was helping me become who I am today. The doctors also thought I would not talk or be able to fully communicate with others because they originally thought my language portion of my brain but they were wrong there to as you can obviously tell because I am writing this today and I got through school, a bachelors program, and received a Masters in Social Work almost ten years ago. My favorite thing to do is write to educate others about disabled people. The main thing I must say is that tolerance for differences is the biggest thing. Also do remember disabled persons are just like everyone else with a unique twist added on. Therefore, I must say that having cerebral palsy does not mean that an infant is going to die or that parents should immediately assume the worst because I am proof (along with about five hundred thousand people with Cerebral
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Palsy) that we did not die in infancy and it is not always the worst thing possible. I can say that I personally have lived a productive life and am raising happy, healthy, well-rounded children. Coping and support

When a child is diagnosed with a disabling condition, the whole family faces new challenges. Here are a few tips for caring for your child and yourself:

Foster your child's independence. Encourage any effort at independence, no matter how small. Just because you can do something faster or more easily doesn't mean you should.

Be an advocate for your child. You are an important part of your child's health care team. Don't be afraid to speak out on your child's behalf or to ask tough questions of your physicians, therapists and teachers.

Find support. A circle of support can make a big difference in helping you cope with cerebral palsy and its effects. As a parent, you may feel grief and guilt over your child's disability. Your doctor can help you locate support groups, organizations

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and counseling services in your community. Your child may benefit from family support programs, school programs and counseling.

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BIBLIOGRAPHY
y y y http://www.about-cerebral-palsy.org/diagnosis/index.html http://kidshealth.org/parent/medical/brain/cerebral_palsy.html http://www.livestrong.com/article/92132-effects-cerebral-palsy-childsdevelopment/ y y http://en.wikipedia.org/wiki/Cerebral_palsy#Classification Miller, Freeman & Bachrach, Steven J. (1995) Cerebral Palsy: A Complete Guide for Caregiving. The John Hopkins University Press y y Geralis, Elaine (ed.). (1998) Children with Cerebral Palsy. Woodbine House Stanley, Fiona, Blair, Eve, Alberman, Eva. (2000) Cerebral Palsies: Epidemiology & Causal Pathways. Mac Keith Press y y The Jakarta post - Alpha Amirrachman Hutton JL, Pharoah POD (2006). Life expectancy in severe cerebral palsy. Archives of Disease in Childhood y Merck Medical Manual Entry on Cerebral Palsy

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