About Cerebral Palsy
Cindy Halfman and Jennifer Hurtado
Description:
·
group of disorders relating primarily to
motoric issues (lack of coordination and control) caused by neurologic or nervous
system damage, occurring between the prenatal period and two years of age while
the brain is developing
·
presence of other impairments, such as problems
with sensation, speech, vision, hearing, seizures, and intellectual disability,
depends on the area of the brain damaged
·
causes:
o
70% from prenatal causes (brain injury, infection,
abnormal brain development)
o
20% from brain injury during birth
o
10% from injury after birth (infections like
meningitis or encephalistis, brain injury)
·
risk factors include (but are not limited to) premature
birth, low birth weight, oxygen deprivation, and maternal issues such as
infection or blood clotting problems
·
often diagnosed due to developmental delays hitting
motor milestones (e.g., rolling over, sitting up, etc.); confirmed through measures
such as CT and MRI
·
5 types and common symptoms:
o
spastic
§ most common
type, 70-80% of cases (Reaching for the stars)
§ stiff muscle
contraction impacting legs
§ paralysis
§ abnormal gait
o
dyskinetic
§ impacts muscles
in the limbs and potentially face and tongue
§ abnormal writhing
movements
§ commonly have
speech issues due to dysarthria
o
ataxic
§ balance and
depth perception problems
§ difficulties
coordinating voluntary movement
o
hypotonic
§ poor muscle
tone and increased joint mobility
o
mixed
§ mixture of
characteristics from other types, most commonly of spastic and dyskinetic cerebral
palsy
Prevalence:
·
2 out of every 1,000 newborn children
·
40% of cases are considered severe
·
most common motor disorder in children
·
2nd most common disability in
children (behind autism)
(Above
information provided by website resources.)
Effects on
Language and Literacy:
Cerebral
palsy is primarily defined by motor issues rather than intellectual deficit. Huge variance exists in the cognitive
abilities of people with CP depending on the type of CP, severity, and the
location of brain damage. As a result,
abilities in all components of language and literacy vary as well and need to be
considered on a case by case basis when working with children with CP. The following are descriptions of trends
that have been identified within the CP population in some areas of literacy
and language development.
Impact
on the Development of Components of Literacy
·
Motivation (Majnemer,
A., Shevell, M., Law, M., Poulin, C., Rosenabaum, P., 2010)
o
Children with minimal motor deficits and few deficits
in communication, social, and self-care skills are typically more motivated.
o
The family’s perspective on the disability has
an impact on the child’s motivation (e.g. if disability is a heavy financial and
emotional burden on the family, the child is more likely to demonstrate low motivation).
o
Children with more motor deficits are more likely
to have increased levels of emotional difficulty handing failure, which potentially impacts their motivation to attempt tasks
they perceive as challenging.
o
Children with good motor function, few functional
limitations, and good cognition demonstrate high levels of persistence in some everyday
tasks.
o
Children with hyperactivity and lack of peer
support demonstrate low motivation
o
Having low motivation affects the child’s potential
and effectiveness of interventions.
o
Strategies to enhance motivation in children with
CP include:
§ Encourage the
child to be less dependent on an adult (e.g. parent, therapist); do not reinforce
their dependence on an adult to complete most tasks
§ Structure activities
so that the child experiences a sense of success at the initiation of the activity
§ Encourage
group activities with fellow peers.
Group activities will provide the opportunities for peers to model
behaviors
·
Comprehension (Asbell, S., Jacobus, D., Tubbergen, M.V., & Warschausky, S. , 2010)
o The development of comprehension skills in children
with CP parallel that of their typically developing peers, and the same variables
can be used to predict their comprehension skills.
o However, children with CP rely on phonological
processing for longer.
o Fine and gross motor abilities do not have an
effect on reading comprehension.
·
Fluency
o Motor
issues will affect the child’s fluency but will be dependent on the type and
severity of cerebral palsy.
§ Children
with a dyskinetic form of cerebral palsy are more likely to have dysarthria,
which will impact fluency.
o
All aspects of fluency (i.e. rate,
accuracy, and prosody) may be impacted.
·
Phonological
Awareness (Peeters et al., 2008)
o
Intelligence and speech
abilities in children with CP relate to their phonological awareness.
o
Kids with CP are at a disadvantage
in terms of the development of phonological awareness, especially in cases where
the children also exhibit speech problems.
o
The
development of basic skills such as phonological awareness will impact the development
of other skills in areas such as phonics and phonemic awareness. The extent of this is most effectively examined
on a case by case basis.
·
Writing
o
Variation in fine motor abilities
will affect the child’s writing skills.
-language/literacy skills affected by motoric ability, if average receptive language - motoric ability can affect how child "plays" with language and speech and affects development of phonological awareness, phonics, phonemic awareness.
Influence
on the Language Foundations of Discourse
·
Expressive
and Receptive Language (Pirila, S. et. al, 2007)
o
Children with more severe forms - severe motorically? of cerebral
palsy demonstrate a higher prevalence of expressive and receptive language
deficits compared to children with less severe forms of the disorder.
o
Results demonstrated that when comparing
children with cerebral palsy and different levels of intelligence, children
with an IQ above 70 had fewer receptive and expressive language deficits than
children with an IQ lower than 70.
·
Phonological
and articulation skills (Pirila et. al,2007)
o
Results demonstrated that children with a
lower intelligence level:
§ Had more problems
with phonological and articulation skills (compared to those with higher intelligence)
§ Used AAC
devices more frequently (compared to those with higher intelligence)
§ Attended speech
treatment more often than children with CP and a higher intelligence level
·
Narrative
Abilities (Holck, Sandberg, and Nettelbladt, 2010)
o
Children with CP perform slightly
worse than typically developing peers in both linguistic and cognitive related narrative
measures.
o
Areas of potential difficulty
include cohesion in narratives, scarcity of essential information, inferencing,
and recall.
o
Children with CP performed lower
on literal comprehension questions at the text level compared to typical peers but
equivalently at the sentence level.
References:
·
Asbell, S., Donders, J., Van Tubbergen, M., &
Warschausky, S. (2010). Predictors of Reading Comprehension in Children with
Cerebral Palsy and Typically Developing Children. Child Neuropsychology,
16(4), 313-325.
·
Geytenbeek, J., Harlaar, L., Stam,
M., Ket, H., Becher, J. G., Oostrom, K., & Vermeulen, J. (2010). Utility of
Language Comprehension Tests for Unintelligible or Non-Speaking Children with
Cerebral Palsy: A Systematic Review. Developmental Medicine & Child
Neurology, 52(12), 1098.
·
Holck, P., Dahlgren Sandberg, A., & Nettelbladt,
U. (2011). Narrative ability in children with cerebral palsy. Research In
Developmental Disabilities, 32(1), 262-270.
·
Majnemer, A., Shevell, M., Law, M., Poulin,
C., & Rosenbaum, P. (2010). Level of motivation in mastering challenging
tasks in children with cerebral palsy Annette Majnemer et al. Motivation in
Children with CP. Developmental Medicine & Child Neurology, 52(12),
1120-1126.
·
Peeters, M. M., Verhoeven, L. L., van Balkom,
H. H., & de Moor, J. J. (2008). Foundations of phonological awareness in
pre-school children with cerebral palsy: the impact of intellectual disability.
Journal Of Intellectual Disability Research, 52(1), 68-78.
·
Pirila, S., van der Meere, J., Pentikainen,
T., Ruusu-Niemi, P., Korpela, R., Kilpinen, J., & Nieminen, P. (2007).
Language and Motor Speech Skills in Children with Cerebral Palsy. Journal Of
Communication Disorders, 40(2), 116-128.
Websites:
·
PubMed Health Cerebral Palsy (2012)
·
My Child Without Limits Cerebral Palsy (2012)
·
Reaching for the Stars Cerebral Palsy Facts and Figures (2012)
Multimedia
Examples:
·
Cerebral Palsy
o
Information
video from the UK’s National Health services that discusses prevalence, causes,
symptoms, and treatment; shows video of individuals with CP
·
Communication: children with cerebral palsy
o
Discussion
of the necessity for and approaches to speech therapy for children with cerebral
palsy
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