Early Childhood Education

Cerebral Palsy (CP)

Cerebral palsy (CP) is a term used to describe a group of chronic disorders that impair control of movement. The term can describe impairment such as paralysis, weakness, loss of coordination, or functional abnormality of the motor system due to brain pathology. This disorder was initially known as Little’s Disease after an English surgeon John Little from the nineteenth century. Winthrop Phelps, M.D, later coined “cerebral palsy” and in 1937 founded the first treatment facility in the United States (located in Baltimore, MD) dedicated to children with CP. Presently, the center is known as the Kennedy Krieger Institute.

Data from the National Health Interview Survey—Child Health Supplement (1988) reports that 23 of 10,000 children seventeen years of age and under had CP within the United States. In recent figures, the prevalence rate of CP remains the same, occurring in 2-2.5 per 1,000 live births, which makes it the most common severe physical disability affecting children. Disabilities ranging from CP as well as other learning disabilities have a substantial impact on the educational and health functioning of the individual children. These children have 1.5 times more doctor visits, 3.5 times more hospital days, twice the number of missed school days, and an increased likelihood of repeating a grade in school in comparison to children without these conditions (Boyle, Decoufle, and Yeargin-Allsopp, 1994).

There are three types of CP identified by the type of movement problems: spastic, athetoid, and ataxic. Spastic CP accounts for 70-80 percent of the cases in the United States. A child with spastic CP can have stiff muscles or may be unable to relax his muscles. Atheoid CP accounts for 10-20 percent of all CP cases. With this type, children have difficulty controlling the muscles of the body. Ataxic CP accounts for 5-10 percent of all cases within the country. A child with ataxic cerebral palsy has problems with balance and coordination. The various cases can also be broken down according to the body part involved: hemiplegia, diplegia, and quadriplegia. Hemiplegia is a type of CP that affects one arm and one leg on the same side of the body. Diplegia, on the other hand, primarily involves reduced functionality in both legs. Quadriplegia refers to CP that affects all four extremities as well as the trunk and neck muscles.

CP can be congenital as a result of either pre- or perinatal trauma and injury or acquired after birth. Certain causes of CP are preventable or treatable, such as head injury, contraction of rubella (German measles) by the pregnant mother, Rh incompatibility, meningitis, or jaundice. Although symptoms can change over time, CP is not a progressive disorder that increases impairment within the child over time. Different symptoms of CP will arise dependent upon the part of the brain that has been injured. Children diagnosed with CP may demonstrate a variety of symptoms such as difficulty with fine motor tasks (e.g., writing), difficulty maintaining balance or walking, and involuntary movements. The early signs of CP appear usually before the age of three. Often, physicians can diagnose a child by eighteen months due to lags in attaining developmental milestones. Infants with this disability can be slow to attain developmental milestones such as rolling over, sitting, crawling, smiling, or walking.

There is currently no cure for CP. However, treatment can improve the individual’s quality of life. Treatment can include: physical therapy and occupational therapy to improve the individual’s motor coordination and balance; medication to help reduce spasms and involuntary muscle movements; surgeries; and braces to increase functionality in the family, school, and work settings. Many state- and federally funded programs are in place to improve the lives of children with disabilities. The Rehabilitation Act of 1973, the Individuals with Disabilities Education Act (IDEA), and the Americans with Disabilities Act are in place to guarantee that Americans with disabilities will not face discrimination in receiving federal financial assistance in schools, workplace, and in other public settings.

States are required to provide assistance for families who take responsibility for children with CP. For children up to the age of three, early intervention provides assistance to families. Staff work with the family to develop an Individualized Family Service Plan (IFSP) to describe the child’s individual needs and the services the child will receive in order to address those needs. For school-aged children, special education services will be provided through the school system. The staff will work with the family to formulate an Individualized Education Plan (IEP) to meet the needs of the child. In addition to therapy services, children with CP may need assistive technology (e.g., communication devices or computer technology) to improve quality of life. Early childhood educators can play a critical role in creating a supportive, inclusive environment for children with CP. By catering to the child’s individual needs, educators and family can collaborate to provide both an appropriate learning and social environment conducive to productivity.

Further Readings: Boyle, C. A., P. Decoufle, and M. Yeargin-Allsopp (1994). Prevalence and health impact of developmental disabilities in US children. Pediatrics 93(3), 399403; McDonald, E. T., and B. Chance Jr. (1964). Cerebral palsy. Englewood Cliffs, NJ: Prentice-Hall.

Web Sites: Centers for Disease Control and Prevention. Cerebral Palsy. Available online at http://www.cdc.gov/NCBDDD/dd/ddcp.htm; Kennedy Krieger Institute. Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine. Available online at http://www.kennedykrieger.org/.

Sonia Susan Issac