Physical · Cerebral Palsy

What is it?

Cerebral palsy is a permanent physical condition that affects a person’s ability to move and balance.

What causes it?

It is caused by an injury to the brain, usually before birth. Its effect can be as mild as just a weakness in one hand ranging to almost complete lack of movement.

Incidence

Cerebral Palsy is diagnosed in approximately 1 in 500 births.

Medical Considerations

The type of cerebral palsy that occurs depends on the part of the brain that is affected.

Spastic cerebral palsy

Movements of an affected arm or leg are stiff and jerky. Some muscles may become permanently shortened and stiff. There are different words that are used to describe the type of types of spastic cerebral palsy. For example:

• Hemiplegia - means that the leg and arm of one side of the body are affected.
• Diplegia - means that both legs are affected. Arms are not affected or are only mildly affected.
• Quadriplegia - means that both arms and legs are affected. Arms are equally or more affected than legs.

Athetoid or dyskinetic cerebral palsy:

People with this type of cerebral palsy may have slow, writhing movements of the hands, arms, feet, or legs while some have sudden muscle spasms.

Ataxic cerebral palsy:

People with ataxic cerebral palsy have difficulties with balance and fine movement. This can mean loss of balance, being unsteady when walking or undertaking fine motor tasks.

Mixed cerebral palsy:

People with mixed cerebral palsy have a combination of two or three of the above types.

Characteristics

Movements can be unpredictable, muscles can be stiff or tight and in some cases people can have shaky movements or tremors. People with cerebral palsy may have seizures and other impairments affecting speech, vision, hearing and/or intellect.

Support

Students with Cerebral Palsy may need some physical modifications in the classroom and technological support to provide alternatives to writing.

Further Information

Cerebral Palsy Australia

Lesson Preparation & Materials

• Provide alternatives to writing for the student to demonstrate learning. If handwriting continues to be difficult for the student, reduce expectations for copying, provide extra time for written work and explore the use of a dedicated word processor and writing software.
• Provide checklists, graphic organisers, visual references and examples to help the student plan ahead and to stay on-task.
• Break into smaller, manageable sections.
• Investigate assistive technologies. Parents may have information available from occupational therapists.
• Classroom modifications for the physical environment may be required. These may include accommodations for mobility equipment (e.g., wheelchairs, standing frames, walkers) or supportive seating.

Teaching Strategies

• Break tasks and assignments into short, easy-to-manage steps. Provide each step separately and give feedback along the way.
• Provide copies of notes or use student writers if handwriting is difficult.
• Provide clear expectations, consistency, structure and routine for the entire class. Rules should be specific, direct, written down and applied consistently.
• Give clear, brief directions. Give written or visual directions as well as oral ones. Allow extra time for oral responses.
• Teach strategies for what to do while waiting for help (e.g. underline, highlight or rephrase directions; jot down key words or questions on sticky notes).
• If the student uses an alternative form of communication, like a communication book or device, make sure it is available to him or her at recess and lunchtime. Teach peers how interact with the student using the communication device or book.
• Use low-key cues, such as touching the student's desk to signal the student to think about what he or she is doing without drawing the attention of classmates.
• Use instructional strategies that include memory prompts. Teach strategies for self-monitoring, such as making daily lists and personal checklists for areas of difficulty.

Feedback & Assessment

• Find out about the student's strengths, interests and areas of need. It is important to know the routine for any medications and specific symptoms. Familiarise yourself with the student’s health care plan for classroom management and excursion planning.
• Provide extra time for tasks or reduce the amount of written work required.
• Develop a system for sharing information with relevant staff members about the student's condition and successful strategies.

Classroom Management

• Some students have organisational problems which affect handwriting and planning. Consider the option of a computer if appropriate.
• Allow for extended travel time from class-to-class.
• Use eye contact or the student’s name to ensure focus during instruction.
• Ensure that student strengths are recognised and highlighted in group tasks.
• Be aware of physical considerations during practical tasks and provide subtle support.
• Schedule bathroom breaks or allow student to leave class just prior to other students to avoid the rush.
• Specialised seating may be required if student uses a wheelchair.

Peers & SLSOs

• Consider ways to activities and structure opportunities for recess and lunch with peers.
• Ensure that the student is involved in peer activities and doesn’t get ‘singled out’.
• Practical tasks may need peer support due to gross motor problems.

Have I...

• Provided assistive technologies?

• Displayed unit outlines, objectives and schedules in the classroom?

• Broken tasks down into smaller, manageable steps?

• Developed subtle signals between teacher and student?

• Arranged for special provisions in assessment tasks – writer, extra time, separate supervision?