Deafness and Cerebral Palsy

1. Deafness and Cerebral Palsy Karen Johnston CEP 859 June 5, 2008

2. Why should deaf educatorsknow about cerebral palsy? • It is estimated that some 764,000 children and adults in the United States manifest one or more of the symptoms of cerebral palsy. • Currently, about 8,000 babies and infants are diagnosed with the condition each year. • 1,200 - 1,500 preschool age children are recognized each year to have cerebral palsy. • 20% of children with cerebral palsy display hearing or language problems. • 3.3% of deaf or hard of hearing children have cerebral palsy (United Cerebral Palsy 2001) (Anthony, T. 1993) (Rhoades, Price, Perigoe 2004)

3. So what exactly is cerebral palsy? Cerebral refers to the brain and palsy to muscle weakness/poor control From United Cerebral Palsy: “Cerebral palsy, also referred to as CP, is a term used to describe a group of chronic conditions affecting body movement and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development; before, during, or shortly after birth; or during infancy. Thus, these disorders are not caused by problems in the muscles or nerves. Instead, faulty development or damage to motor areas in the brain disrupt the brain's ability to adequately control movement and posture.”

4. Are there different types of CP? There are three main types of CP*: • Spastic which produces stiff and difficult movement • Athetoid which produces involuntary and uncontrolled movement • Ataxic which produces a disturbed sense of balance, position in space and general uncoordinated movement *These three types of CP may also occur in various combinations.

5. What physical effects of CP might we observe in our students? • Underdeveloped motor skills • Slow to reach developmental milestones (rolling over, sitting, crawling, smiling, walking) • Abnormal or vacillating muscle tone • Decreased muscle tone- Hypotonia • Increased muscle tone- Hypertonia (stiff and rigid) • May favor one side of the body or one movement pattern • Unusual and often awkward posture • May walk on tip toes or may carry arms high in “high guard position” for balance • May demonstrate difficulty with head control and older may hold head in awkward position • Possible seizures and tremors – often take medication to reduce frequency • May focus locally on surroundings and not view the larger play area – may demonstrate poor visual acuity

6. What are the other potential effects of CP? • difficulty in swallowing and problems with speech • abnormal sensation and perception • impairment of sight, hearing, or speech • difficulties in feeding, bladder and bowel control • problems with breathing because of postural difficulties • skin disorders because of pressure sores • learning disabilities • cognitive impairments

7. What can be used to minimize the effects of CP and maximize student’s potential? • Medical equipment • Communication devices • Training and therapy

8. What medical equipment might be used by students who have CP? • Braces • Custom splints • Walkers • Wheelchairs

9. What communication devices are available for students with CP? • Manual communication boards • picture boards • alphabet/word boards • BIGmack (http://www.ablenetinc.com) • pre-recorded messages • Dynavox (http://www.dynavoxsys.com/) • touch menu with communication categories • Delta Talker (http://www.prentrom.com) • picture and word keyboard

10. What type of therapy is available for students with CP? • Physical therapy (PT) • helps develop stronger muscles such as those in the legs and trunk • Occupational therapy (OT) • helps develop fine motor skills such as dressing, feeding, writing, and other daily living tasks. • Speech-language pathology (S/L) • helps the child develop his or her communication skills

11. What are other challenges we can help our students with CP overcome? “The challenges for a child with a motor delay go way beyond having a hard time writing or running, jumping, and skipping. All of these are surface problems compared to the task of enabling a child to master intellectual, social, and emotional development, despite his motor limitations.”

12. How can we foster intellectual, social, and emotional development in children with CP? • Capitalize on every opportunity to allow the child a sense of accomplishment • Use all of the child's operating senses and abilities • Use peer interactions to give child a sense of control • Create social games in which the child does not have to be just a passive follower (Greenspan 2002)

13. What should teachers of D/HH students with CP consider when planning? • What does the child like to do? • Are there activities that pose problems because the child doesn't seem to pay attention (i.e., shift gaze, focus on person or object, tracking, use good eye-hand coordination)? What are these activities? • Which position(s) is best for visual activities? Auditory activities? Hand-eye activities? • How do I get the child into each of these positions? What tips do you have for getting the child into these positions without hurting the child or the adult? • What positions place high energy demands on the child? • What positions make it difficult for the child to use her vision? Hearing? • What other types of activities can she do in those positions? • Will the child need any special equipment for positioning in various activities? • Will the child's hearing aid be adequate for the activity or should other devices such as an FM system be considered? Are any low vision devices needed for the activity? What about augmentative communication devices? • How will his hearing aid and/or low vision devices interface with adaptive equipment and augmentative communication devices? (Shafer & Moss)

14. What resources are available? United Cerebral Palsy (http://www.ucp.org/) • “United Cerebral Palsy (UCP) is the leading source of information on cerebral palsy and is a pivotal advocate for the rights of persons with any disability. As one of the largest health charities in America, the UCP mission is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network.” Cerebral Palsy and Deaf Organization (http://www.cpado.org/) • “Our mission is to provide a website that welcomes those who share the combined challenge of cerebral palsy and deafness.  We are here to reach out to others and to offer a place to ask questions, discuss topics, find out what's happening, or contribute personal experiences.” Cerebral Palsy Fact Sheet (http://www.pecentral.org/adapted/factsheets/CerebralPalsy.htm) • An article from PE Central that centers on assessment, teaching strategies, and considerations for students with CP in gym class

15. References Greenspan, S. I. (May 2002). Working with the child who has cerebral palsy. Scholastic Early Childhood Today. 16(7), 16-17. Kahn, Alisa B. New Horizons for Learning. Retrieved June 4, 2008, from Assistive Technology for Children who have Cerebral Palsy: Augmentation Communication Devices Web site: http://www.newhorizons.org/spneeds/inclusion/teaching/kahn.htm National Dissemination Center for Children with Disabilities, (2004, January). Cerebral Palsy. Retrieved June 4, 2008, from National Dissemination Center for Children with Disabilities Web site: http://www.nichcy.org/pubs/factshe/fs2txt.htm PE Central, Cerebral Palsy Fact Sheet. Retrieved June 4, 2008, from PE Central Web site: http://www.pecentral.org/adapted/factsheets/CerebralPalsy.htm Rhoades, E.A., Price, F., & Perigoe, C.B. (2004). The changing American family and ethnically diverse children with hearing loss and multiple needs. Volta Review. 104, 285-305.

16. References (continued) Robinson, R. O. The frequency of other handicaps in children with cerebral palsy. Developmental Medicine and Child Neurology. No. 15, 1983. pps. 305-312. Shafer, S., & Moss, K. Cerebral Palsy and Children with Vision and Hearing Loss. See Hear Newsletter, Retrieved June 2, 2008, from http://www.deafblind.com/cerebral.html. United Cerebral Palsy, (2001, October). Cerebral Palsy - Facts & Figures. Retrieved June 2, 2008, from United Cerebral Palsy Web site: http://www.ucp.org/ucpgeneraldoc.cfm/1/9/37/3737/447