12 Cerebral Palsy

What is Cerebral Palsy?

Cerebral palsy (CP) is a permanent physical condition that affects movement. There are three main types of CP and each involves the way a child moves. Movements can be unpredictable, muscles can be stiff or tight and in some cases children can have shaky movements or tremors. CP can be as mild as just a weakness in one hand ranging to almost complete lack of movement.

Children with CP may have seizures and other impairments affecting their speech, vision, hearing and/or intellect.

CP, except in its mildest forms, can be seen in the first 12-18 months of life. It presents when children fail to reach movement milestones. Babies most at risk of cerebral palsy are those born prematurely or with low birth weight.

Worldwide, the incidence of CP is 1 in 400 births. There is no known cure and severity is on the increase. For most, the cause of CP is unknown.

Types of CP

There are three main types of CP:

• Spastic cerebral palsy – This is the most common type of CP. Spasticity means stiffness or tightness of muscles. The muscles are stiff because the message to the muscles is sent incorrectly through the damaged part of the brain.
  When children without CP perform a movement, some groups of muscles become tighter and some groups of muscles relax. In children with spastic CP, both groups of muscles may become tighter. This makes movement difficult or even impossible.

• Athetoid cerebral palsy – Athetosis is the word used for involuntary unpredictable movements that occur in this type of CP. This involuntary movement is present even at rest and is often most noticeable when the person moves. Children with athetoid cerebral palsy often have very weak muscles or feel floppy when carried.
• Ataxic cerebral palsy – This is the least common type of CP. Ataxia is the word used for unsteady shaky movements or tremor. Children with ataxia also have trouble keeping their balance. Many children do not have just one type, but a mixture of several of these movement patterns.

What part of the body is affected by CP?

This is different from one person to another. In CP, certain words are used to describe the parts affected:

• Hemiplegia – the leg and arm on one side of the body are affected. See Factsheet 13 for more information on Hemiplegia.
• Diplegia – both legs are affected significantly more than the arms. Children with diplegia usually have some clumsiness with their hand movements.
• Quadriplegia – Both arms and legs are affected. The muscles of the trunk, face and mouth can also be affected.

What causes CP?

CP results from damage to part of the brain. The term is used when the problem has occurred to the developing brain, usually before birth. For most children with CP, the cause is unknown. The risk is greater in babies born preterm and with low birthweight. Whilst the reasons for this remain unclear, CP may occur as a result of problems associated with preterm birth or may indicate an injury has occurred during the pregnancy that has caused the baby to be born early. In some cases, damage to the brain may occur:

What can the childcare/preschool do to help?

The preschool / childcare centre can enhance a child’s development by:

• Remembering a child with cerebral palsy is very much like any other child. The child gets the same enjoyment as other children from play.
• Focussing on what a child can do and the ways in which the child’s capabilities can be developed to his her maximum potential.
• Allowing the child the opportunity to participate in all aspects of the program.
• Remaining optimistic yet realistic about the child’s progress.
• Working closely with parents and early childhood intervention professionals to help the child maximise his/her potential.

What is early childhood intervention.

Facilitating Successful Inclusion

One of the most important aims of including children with cerebral palsy into mainstream childcare settings is the development of social competence and self esteem.
Successful inclusion means being included in all the daily activities of the early childhood setting including free play, group times, routines and transition between activities.

As with any child, a child with cerebral palsy may develop at different rates in different areas. It is important to get to know the child’s strengths and needs in all areas of development, as well as interests, likes and dislikes, to plan and support learning, and to include the child as fully as possible.

It is advisable that families and all agencies involved, including centre staff, cooperate in planning a smooth transition to the centre. This can be done through sharing information and arranging visits before the child starts at the centre. At a later stage, an Individualised Education Program (IEP) can be developed through joint meetings.

Ideas to consider:

• Ensure that all staff members at the centre are familiar with the strengths and needs of the child with cerebral palsy and can be involved in supporting the child. This reduces dependence on any one staff member.
• Appropriate positioning of children with cerebral palsy enhances participation and maximises skill development, social interactions and independence. It also decreases the need for a constant 1:1 child staff ratio with them.
• It is important not to leave a child at the same activity or in the same position for extended periods.
• Plan ahead by having any equipment or modifications that may be needed by the child ready at the appropriate activities. Also, ensure that all activities are easily accessible with clear spaces allowing access with walking frame or sticks.
• Some children with cerebral palsy may not be motivated to play and explore and may require some help to learn to play.
• Provide opportunities to allow the child to participate as fully and independently as possible. Plan to allow play without an adult always in immediate proximity – this encourages other children to view the child in his / her own right as part of their group and provides opportunities for social interactions which may otherwise not occur.
• Children with cerebral palsy may need to be allowed more time to complete activities and move from one activity to another. They may also need opportunities to demonstrate understanding in their own ways.
• Making the most of routines: by incorporating the preschool routine into programming, children with additional needs are provided with further opportunities to practise specific skills in a busy group situation. As with all children at the centre, it is important to expect the child with cerebral palsy to follow the rules and routines of the group.

Unit Attribution

Adapted from Cerebral Palsy Alliance (2018). Preschool Fact Pack: A Guide for Early Childhood Staff. https://worldcpday.org/wp-content/uploads/2015/10/preschool_fact_pack.pdf