Cerebral Palsy Is A Condition
Cerebral Palsy is a condition, which can be caused by a brain injury, or abnormal brain development that occurs while a child’s brain is still developing. The onset of Cerebral Palsy can happen before, during, or immediately after birth. Cerebral Palsy primarily affects fine motor skills, gross motor skills and oral motor functioning. Further more, it can affect body movement, muscle control and tone, coordination, reflexes, as well as posture and balance (About Cerebral Palsy, n.d.). Contraindications associated with Cerebral Palsy include seizure disorders, spine instability, brain damage, and pronounced psychiatric disorders ("Rehabilitation of Patients With Cerebral Palsy," 2017). In regards to signs and symptoms of Cerebral Palsy, they aren’t always apparent at birth. The child will most likely experience a delay in development and growth milestones, such as rolling over, crawling, sitting and walking ("What Are the Earliest Signs of Cerebral Palsy?," n.d.). There are different types of Cerebral Palsy (CP), which are categorized by the type of movement disturbance. Spastic CP, which is the most common type, involves muscles that are stiff/weak and athetoid CP includes slow, squirming and involuntary movement. Ataxic CP involves muscle weakness, poor coordination, and tremors. Lastly, mixed CP combines spastic and athetoid side effects (Boyt Schell, Gillen, & Scaffa, 2014, p. ).
Personal and environmental factors are affected when an individual has Cerebral Palsy. In addition, there are physical and mental pieces that contribute to person factors. First and foremost, some physical difficulties a person with Cerebral Palsy might experience are mobility issues, visual impairment, speaking, hearing impairment, epilepsy, hip and spine abnormalities, and bowel/bladder control ("How does cerebral palsy affect people?," n.d.). Mental aspects can involve having an intellectual disability, which is common for people who have CP. Generally, the greater the level the persons physical impairment is, the more likely it is that there will be an intellectual disability present. Some environmental factors that can contribute to Cerebral Palsy include low birth weight, prematurity, poor maternal health, twins/triplets, maternal infections, lack of blood flow/oxygen to fetal brain, blood type incompatibility and contact to toxic substances (Boyt Schell et al., 2014, p. 1127-1128).
Typically, Cerebral Palsy is diagnosed within the first two years of life, but it all depends on the severity of the diagnosis. In severe cases, the diagnosis can be made soon after birth, but those who have more mild symptoms may not be diagnosed until three to five years of age when the brain is fully developed ("Cerebral Palsy Diagnosis," n.d.). Cerebral Palsy’s impact on occupational performance is dependent on the individuals age and what occupational roles they are at part of during that time. If an infant gets diagnosed with CP soon after birth (in terms of a severe case of CP) their occupational performance will be hindered by sleep disorders, which is a major occupation in infants. An infant may have a visual deficit, epilepsy, or even pain that can hinder them and their sleep patterns. Around six months of being diagnosed with Cerebral Palsy as an infant, there may be signs of difficulty with visual attention, abnormal muscle tone, poor head control, unable to push up while lying at the stomach only reaching out with one hand while keeping the other in a fist and the inability to bring the hands together ("What Are the Earliest Signs of Cerebral Palsy?," n.d.). Cerebral Palsy seen in babies older than ten months may demonstrate the inability to sit independently without supports and the inability to stand without support. When it comes to ambulating, an infant at this age may exhibit a lopsided crawling reflex, which is when the baby pushes off with one hand and leg while dragging opposite hand and leg ("What Are the Earliest Signs of Cerebral Palsy?," n.d.). These deficits, between the ages of six months and one year old, can greatly affect the infant’s occupational performance of play and exploration. When discussing the same case (where a child is diagnosed with CP soon after birth) at five years old, this child might have speech problems, food aspiration, drooling, osteoporosis, lack bowel and bladder control and behavioral issues (Hirsch, 2015). The main occupations of a child at this age include play, sleep, school participation and social participation. The deficits previously listed for a five year old with CP can really hinder their occupational performance in more broad areas. For example, if the child has behavioral issues, they will most likely have trouble making friends and may even perform negatively in their schoolwork.
A common treatment team involved with working on a plan for someone with Cerebral Palsy may include a physical therapist/physical therapy assistant, a physician, a surgeon, teachers (if involved in a school setting), caregivers and an occupational therapist/occupational therapy assistant (Boyt Schell et al., 2014, p. 1127-1128). An occupational therapist must evaluate a client with CP to determine the client’s ability to participate in society and meaningful occupations. This is extremely important because evaluations can determine the need for assistive technology and is necessary across the life course since specific needs may change with age (Boyt Schell et al., 2014, p. 1127-1128). Some goals and interventions an occupational therapist may implement when working with someone who has Cerebral Palsy can include maintaining upper and lower extremity range of motion, preventing spasticity and contractures, as well as adapting the home, school and overall environment of the individual to promote independence and success. The occupational therapist may also educate either the client or caregiver on strengthening exercises, how to manage daily tasks and create beneficial routines. Another important task occupational therapists work on is feeding. Feeding for those with CP can potentially be impossible or messy. Caregivers, such as mothers, can be the ones who do the feedings most of the time if the individual is unable to do it on their own. In one study, children between six months and four years old and their mothers, who reported feeding difficulties, were chosen. Each child was assessed on oral the Oral Motor Dysfunction Scale (OMD) to assess the level of their functioning and to help decide the correct intervention and the mothers were assessed on WHOQOL-Bref and COPM. The study came to the conclusion that there was scientific support for the use of occupational therapy intervention since it has a positive effect on the oral motor abilities of children with Cerebral Palsy. Mothers who were knowledgeable of specific feeding techniques could help them care for the child better, but didn’t prevent the guilt and anxiety about perception of self-performance (Siddharth & Gupta, 2016, p. 160).
A main precaution for people with Cerebral Palsy is being prone to falls or accidents. Specifically, if the individual has epilepsy, being cautious of seizures is something that is greatly important to an occupational therapist so they can improve the safety of that person and prevent any possible injuries that may occur ("Safety Tips," n.d.). When working with children, an occupational therapist should supervise them, have them wear protective gear (if seizures tend to occur) and make sure that their shoes are in good condition to avoid slips and falls. With adults who have Cerebral Palsy, occupational therapists can assist with padding sharp corners in the home, encourage the use of protective devices, keeping areas clear of clutter, prevent cords from hanging low, avoid throw rugs and encourage skid-proof mats on floors and under bowls/plates so spills don’t occur ("Safety Tips," n.d.).
People with Cerebral Palsy can be prescribed for muscle relaxants (antispasmodics), anticonvulsants and anticholinergics. Baclofen, Botox, and Diazepam are all examples of possible prescribed medications to help reduce muscle spasms. These may not be given growing children due to the side effects causing problems with drowsiness, which can affect their concentration in school ("Cerebral Palsy: Medications," n.d.). Examples of anticonvulsants (help prevent/control seizures) are Lamotrigine and Oxcarbazepine, and they have the possible side effects of dizziness, headache, blurred vision, loss of coordination, nausea/vomiting and trouble sleeping. This should be taken into consideration when working with someone who has Cerebral Palsy because it can affect their activities of daily living and occupational roles in regards to focus, social participation and even sleep. Benztropine and Glycopyrrolate are examples of anticholingerics (help with uncontrollable body movements and drooling), which include dry mouth, drowsiness, constipation, nausea and blurred vision as possible side effects ("Cerebral Palsy: Medications," n.d.). These side effects can negatively affect a person with CP because since they most likely have swallowing/oral functioning issues, dry mouth is something to be aware of as an occupational therapist. Also, people with Cerebral Palsy tend to have constipation, so taking a medication that may cause constipation should be noted as well.
In conclusion, Cerebral Palsy is a diagnosis that is typically diagnosed very early in the developmental process, making it so that it affects the necessary developmental milestones to become delayed, but early intervention is highly recommended. Cerebral Palsy is a chronic disability that is with an individual for the rest of their life. There is no cure, it is not progressive and it is non-communicable. It looks different in everyone who has it, so remaining client-centered and occupation based will keep the interventions to be beneficial. An occupational therapists’ main when working with a client who has Cerebral Palsy is collaborating with the interdisciplinary team to ensure that individual is receiving the best care, assist in treatment plans, creating adaptations to help the individual to be as independent as possible, helping them with social participation and activities of daily living, and improving the individuals overall quality of life.