1 RUNNING HEAD: Cerebral Palsy & Intervention Methods Cerebral Palsy & Intervention Methods, 1 Cerebral Palsy: Intervention Methods for Young Children Emma Zercher San Francisco State University May 21, 2012
2 Cerebral Palsy & Intervention Methods Zercher, 2 Cerebral palsy is a disorder of movement and posture that is caused by a nonprogressive abnormality of the immature brain. The brain continues to grow through early adulthood, but the crucial events of its development occur during intrauterine life and early childhood (Pellegrino, 2005). There are four different types of this disorder: spastic, athetoid, axtatic, and mixed (Santos, 2012). Spastic is the most common form, and is further classified by what limbs are involved. Spastic hemiplegia means that one side of the body is more affected than the other, with the arms being more affected than the legs. Spastic diplegia is when the legs are more affected than the arms, and is most frequently associated with premature births. Spastic quadriplegia is when all four limbs, as well as the trunk and all muscles that control the mouth, tongue, and pharynx are affected. Spastic quadriplegia can also be mentally retarded, or have seizures, sensory impairments, and medical complications (Pellegrino, 2005). The second type of cerebral palsy, athetoid, is when an individual has rapid, random, jerky movements, and slow, writhing movements. Axtatic cerebral palsy has abnormalities of voluntary movement involving balance and position of the trunk and limbs in space. This can involve difficulties controlling hand and arms while reaching for something, and can be connected with an increase or decrease in muscle tone. The last type, mixed cerebral palsy, is a term used to identify when an individual may have more than type of motor pattern is present, and is only used when one pattern does not dominate another (Pellegrino, 2005). Cerebral palsy is does not have its own category under the IDEA, and children and families can receive services under the category orthopedic impairments. The IDEA definition for this category is having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational
3 Cerebral Palsy & Intervention Methods Zercher, 3 environment, that (a) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and (b) adversely affects a child s educational performance (NICHCY, n.d.). Cerebral Palsy was previously thought to have been caused by a lack of blood flow and oxygen supply to the brain, usually due to complications during the birthing process. However, research now shows that hardly any diagnoses of cerebral palsy are due to this cause (Nelson & Ellenberg, 1986). Children who are diagnosed with cerebral palsy can be born at full term or prematurely. Babies who are born premature and have had an injury to their white matter of the brain as a result of periventricular keukomalacia or intraventricular hemorrhage are diagnosed with cerebral palsy (Pellegrino, 2005). Children who are born full term are usually small or have malformations inside and outside the central nervous system, which can be linked to problems with early fetal development. As mentioned before, if a full term baby suffers a lack of blood flow and oxygen supply to the grain, they can develop athetoid or dystonic types or cerebral palsy (Pellegrino, 2005). Children with cerebral palsy can also suffer from mental retardation, visual impairments, hearing impairments, speech and language disorders, seizures, feeding and growth abnormalities, and behavior and emotional disorders (Pellegrino, 2005). One half to two thirds of those with cerebral palsy are mentally retarded or have some kind of perceptual impairment or learning disability. Visual impairments are common in those with cerebral palsy, mostly in children born prematurely. Speech and Language as well as hearing impairments can happen to thirty percent of those with cerebral palsy. Forty to fifty percent will have seizures, especially those with a
4 Cerebral Palsy & Intervention Methods Zercher, 4 spastic type. Behavioral and emotional disorders, such as attention deficit/hyperactivity disorder and self injurious behavior can occur in many children with cerebral palsy. These are all characteristics that can be found in children with cerebral palsy (Pellegrino, 2005). There are many different types of intervention methods used for various purposes. One of the methods that is the most common is neurodevelopmental therapy (NDT). This therapy is designed to provide the child with sensorimotor experiences that enhance the development of normal movement patterns (Perin, 1989). This method is meant to be an individualized program of positioning, therapeutic handling, and play that that is specially designed for the child, hoping to improve the normalization tone and the improved control of movement during functional activities. This therapy, designed by Dr. Karel and Berta Bobath is largely used by occupational and physical therapists. Neurodevelopmental therapy is used by focusing on individual handling techniques that are selected according to the child s specific problems with muscle tone and control, cognitive abilities, and motivation to engage in tasks (Kurtz, 2005). Components include handling, in which therapists try to control abnormal patterns of movement while smoothing the progress of more normal motor patterns. This supports motor learning through sensory feedback associated with active movement. This intervention method works when caregivers are taught to include these techniques into a child with cerebral palsy s daily routine, which will promote the frequent practice of the child s newly acquired skills (Darrah & Bartlett, 1995). This method works well for children with cerebral palsy because it increases the rate of improvement in motor development and the quality of motor control. This is good for diagnosed children because children with spastic cerebral palsy have trouble with muscle control and can
5 Cerebral Palsy & Intervention Methods Zercher, 5 suffer physical impairments. With neurodevelopmental therapy, children are able to develop typical movements and responses while using sensorimotor experiences. However, there are many newer theories surrounding motor learning that suggest different approaches in order to show progress in motor development. Therapists are also starting to question the method results, as the carryover of facilitated normal movement patterns to daily functional activities is not always realistic. There are also a number of variables for this type of intervention method, such as the environment, motivation, task requirements, musculoskeletal system, cognition, and practice efforts (Campbell, 1996). These variables can all have a lasting effect on the changes of motor behavior, making this method unsuitable for some children. Neurodevelopmental therapy can be used for autism as well as children with physical disabilities and those who have difficulty with muscle tone. However, this method works best with children who have cerebral palsy, because motor problems of children with cerebral palsy come up fundamentally from dysfunction, which interferes with the development of normal postural control and hinders normal motor development (Butler & Darrah, 2001). This approach focuses on sensorimotor components of muscle tone, reflexes and abnormal movement patters, postural control, sensation, perception, and memory, all which affect those with cerebral palsy. This method was created with the intention of using it to help children with cerebral palsy, and while it has advanced and become broader in who it can help, the principles of the study are the same and therefore benefit children with cerebral palsy. This method obviously would not work for children who do not suffer from physical disabilities or those who suffer from severe physical disabilities, such as paraplegics. This intervention method is beneficial only for those who have trouble with muscle tone and abnormal
6 Cerebral Palsy & Intervention Methods Zercher, 6 reflexes and movement patterns; therefore children suffering from emotional and behavioral disorders will not find it effective. There are few risks for this intervention method, as it is one of the milder forms of intervention for cerebral palsy. Other methods involve using braces and splints, oral medication, nerve blocks, motor point blocks, neurosurgery, and orthopedic surgery (Pellegrino, 2005). Considering the severity of these methods, as well as the potential disadvantages and risks, this method is ideal for intervention. The only risk for this method of intervention is that caregivers who use this method must go through training, and it is only effective if this caregiver can correctly implement proper therapy methods and techniques. In conclusion, cerebral palsy is a disability that results from brain damage, may occur during pregnancy, labor, infancy, or early childhood, and is not degenerative. There are four different types that each has different characteristics. Intervention methods include surgery, oral medication, supports, and most importantly, neurodevelopmental therapy. Neurodevelopmental therapy uses sensorimotor experiences to help children who suffer from abnormal reflexes and muscle movements and lack of muscle tone progress in physical development. While there are small risks, this is the most mild intervention method with the least drastic complications, making it very effective and a positive experience for those with cerebral palsy.
7 Cerebral Palsy & Intervention Methods Zercher, 7 References Butler, C., & Darrah, J. (2001). Effects of neurodevelopmental treatment (NDT) for cerebral palsy: an AACPDM evidence report. AACPDM, 1, Retrieved May 19, 2012, from the psychinfo database. Campbell, S.K., (1996). Quantifying the effects of interventions for movement disorders resulting from cerebral palsy. Journal of Child Neurology, 11(Suppl. 1), S61-S70. Darrah, J., & Bartlett, D. (1995). Dynamic systems theory and management of children with cerebral plasy: Unresolved issues, Infants and Young Children, 8(1), Kurtz, L. (2005). Children with disabilities (5th ed.). Baltimore: Paul H. Brookes. Nelson, K.B., & Ellenberg, J.H. (1986). Antecedents of cerebral palsy: Multivariatv analysis of risk. New England Journal of Medicine, 315, NICHCY. (2012, March 1). Categories of Disability Under IDEA. National Dissemination Center for Children with Disabilities. Retrieved May 19, 2012, from Pellegrino, L. (2005). Children with disabilities (5th ed.). Baltimore: Paul H. Brookes. Perin, B. (1989). Physical therapy for the child with cerebral palsy. In J. S. Tecklin (Ed.), Pediatric physical therapy (pp ). Philadelphia: Lippincott Williams & Wilkins. Santos, S. (Director) (2012, April 19). Physical Disabilities. Young Children with Special Needs/At-Risk and their Families. Lecture conducted from San Francisco State University, San Francisco.