• CHAPTER ANNOTATION

1. INTRODUCTION TO PHYSICAL DISABILITY
2. DEFINING PHYSICAL DISABILITY
3. PHYSICAL DISABILITY CLASSIFICATION
4. CEREBRAL PALSY (CP)
5. CAUSES OF PHYSICAL DISABILITY
6. INTERVENTIONS
7. INCLUSION OF A CHILD WITH PHYSICAL DISABILITY
8. AUTHORS, SOURCES AND LITERATURE

4. CEREBRAL PALSY (CP)

Characteristics of cerebral palsy

CP is a central disorder of movement, which can be divided into three main forms: spastic, athetoid, ataxic, however the forms are often mixed. CP is associated with abnormal muscle tone and problems with coordination of movement.

Spastic form of cerebral palsy is associated with increased muscle tone (hypertonia) keeps the muscles in a constant state of increased tension. The clinical features are connected with damage to the cerebral cortex and corresponding pyramidal tracts. Problems include increased muscular tension due to disrupted brain to muscle communication, thus hindering the normal processes of movement. Main characteristics of this type of CP:

• Motor coordination problems
• Stereotypical movements
• Torpid body posture
• Distorted balance
• Orthopaedic problems

CP may be affecting all limbs (quadruparesis/plegia), lower limbs (paraparesis/plegia) or hemiparesis/plegia – involvement of just one side of the body or just the lower or upper limb on the same side of the body.

Quadruparesis/pelgia – all four limbs are affected and also the head and trunk. Head and trunk are stiff with only limited rotation. Upper limbs are in retraction with adduction of shoulders. Legs are often in extension and adduction and deformed later in life.

Main characteristics:

• Increased muscular tone of the whole body, difficulty in relaxing
• Disordered in motor functions of the whole body including facial muscles
• Orthopaedic problems

Paraparsis/plegia – affected are lower limbs. Lower limbs are often in strong adduction and medial rotation of hips, extension and later on with flexion of knees.

Main characteristics:

• Problems with standing up – hips and knees are flexed
• Delayed walking
• Orthopaedic problems

Hemiparesis/plegia – affected are upper limb and lower limb on the same side of the body. Upper limbs are often in adduction of shoulders, flexion of elbow and hand. Lower limbs are often in inside rotation, adduction and with extension of knees.

Main characteristics:

• Adduction of a thumb, disordered motor control of hands
• Difficulties with parallel arms movement
• Distorted balance
• Orthopaedic problems

The majority of people with cerebral palsy have one or more of the following associated conditions: Epileptic fits of various types, disorders of nervous system, speech and language difficulties (dysarthria, anarthria). Other associated conditions frequently occurring with CP are disorders of perception, emotions, communication and behaviour.

Due to CP or similar physical disability, we can often see in children differences in development of their cognition, memory, intelligence and hand–eye coordination. This can be typically seen in problems associated with differentiating important and non-important stimulus, or figure and background differentiation. Children may also have difficulties solving abstract tasks, attention span and tiredness.

Physical disabilities are also often associated with disorders in social interaction. The cause can be the behaviour of a child with CP that may seem odd to people with no previous experience or knowledge about disabilities. Problems in relationships are often based on the general prejudice against brain disorders and physical otherness. This negative experience complicates the early development of a child and may adversely influence his/her emotional and social development. The child may feel misunderstood, unaccepted and develop negative self-concept with disorders in learning and behaviour.