Cerebral Palsy

1. Cerebral Palsy Joe Conte and Sarah Lupo

2. Video http://www.dailymotion.com/video/x68kwh_cerebral-palsy-wwwbrainpalsycom_shortfilms

3. What is Cerebral Palsy? A group of permanent disabling symptoms resulting from damage to the motor control areas of the brain A non-progressive condition that might originate before, during, or shortly after birth Cerebral = brain Palsy = disordered movement or posture

4. Statistics According to the United Cerebral Palsy Association an estimated 500,000 have cerebral palsy. 10-20% of children with cerebral palsy acquire the disorder after birth. The average lifetime cost for a person with cerebral palsy totals nearly $1 million Cerebral palsy is diagnosed in approx. 8,000 children each year Cerebral palsy is the most common cause of childhood physical disability, occurring in 2-3 out of 1000 children

5. Causes of Cerebral Palsy Illness during pregnancy Premature delivery Insufficient amount/Lack of oxygen supply to the fetus/newborn infant’s brain Lead poisoning Illness early in the infant’s life Child abuse Medical negligence Many times it is unknown

6. Symptoms of Cerebral Palsy • Developmental delay • Abnormal muscle tone • Unusual posture • Early development of hand preference

7. Classifications of Cerebral Palsy Topographical Neuromotor Functional

8. Topographical Based on the body segments afflicted Typically used by medical professionals Classes include: Monoplegia Diplegia Hemiplegia Paraplegia Triplegia Quadriplegia

9. Neuromotor Spasticity Athetosis Ataxia

10. Spasticity Result from damage to motor areas of the cerebrum; characterized by increased muscle tone, primarily of flexors and internal rotators, which might lead to permanent contractures and bone deformities

11. Athetosis A condition that occurs when there is damage to the basal ganglia (masses of gray matter composed of neurons located deep within the cerebral hemispheres of the brain) results in an overflow of motor impulses to the muscles. Some characteristics of this type of CP include slow, writhing movements that are uncoordinated and involuntarily.

12. Ataxia • Condition that occurs when there is damage to the cerebellum (which normally regulates balance and muscle coordination). • Diagnosed when the child attempts to walk. • Muscles show abnormal degrees of hypotonicity. • Conditions • Individual shows lack of balance and coordination necessary for proper arm and leg movement causing a wide-based gait to be exhibited. • Individuals show difficulty with performing basic motor skills and pattern that include locomotor movements such as running, jumping, and skipping.

13. Functional Individuals are placed into one of eight ability classes according to the severity of the disability. Important system for physical education teachers because it categorizes the individuals according to their disability levels. Teachers and coaches can use this classification system to help make the competition among the individuals equal (in competitive activities individuals who have the same classification can compete against each other.

14. Functional

15. Common Characteristics in the Psychomotor Domain Seizures Spastic or rigid muscles Contractures may develop when restricted range of motion is severe Hyperactive Stretch Reflex Scissoring gate or hemiplegic gate Persistence of unwanted primitive reflexes and tremors Involuntary movement (e.g., constant, unpredictable, purposeless movement) May exhibit both hypertonic and hypotonic muscle tone Low postural tone; may be able to walk unaided, usually with arms held out to the sides Often under or over reaches Falls and stumbles easily

16. Common Characteristics in the Cognitive Domain Loss of perceptual ability Difficulty with speech Learning disability or mental retardation

17. Common Characteristics in the Affective Domain Difficulty socializing with their peers May be withdrawn ADHD

18. Teaching Styles Be very patient and use wait time Reinforce language and speech Add weights to implements, such as bats and racquets, to help with tremors or unwanted movements Be careful with how you have them move

19. Exercising with Cerebral Palsy Know the characteristics of each individual and their capabilities Resistance training helps improve overall motor function and even flexibility Isokinetic training Cycle ergometers help with cardiorespiratory endurance

20. Diagnosis • Test reflexes • Check for hand preference • Rule out other disorders that can cause movement problems • Perform CT scan, MRI, and/or ultrasonography • Look for other conditions linked to cerebral palsy

21. How to Manage Cerebral Palsy Management is directed at alleviating symptoms that are caused by damage to the brain and helping the child achieve maximum potential in growth and development.

22. Technology and Cerebral Palsy • Assistive technology • Computers • Communication boards with words or symbol systems • Bikes or scooters • Motorized wheelchairs

23. Treatment Team People involved in the planning, treatment, and decision-making of an individual with cerebral palsy Healthcare professionals who are involved with the individual Family and other caregivers Teachers who know the individual

24. Treatment and Therapy • Since cerebral palsy is so diverse the treatment of it can vary greatly from one individual to another. • There is no cure, but there are many therapies to help people better handle their condition • Physical therapy • Occupational therapy • Botox • Stem cells The focus of treatment is on helping the individual reach his/her highest level of independence. Individualized plans for treating C.P. should be centered around the needs of the individual.

25. Other interesting ways to treat cerebral palsy • Dolphin therapy: • Developed by American psychologist David E. Nathanson around 1978 • Allows children with cerebral palsy to step into a different environment and interact with the dolphin in a way that is both playful as well as constructive for that child.

26. Dolphin Therapy (Continued) • Research has shown that dolphins who are one of the most intelligent animals are actually able to recognize the child’s deficiency which helps the child create a connection with the dolphin. • The connection has been known to help the child relax as well as an openness to learn and heal that can help lead to developmental progress. • http://www.metacafe.com/watch/714493/dolphin_therapy_in_kemer_antalya_turkey/

27. Space Suit Therapy Becoming increasingly popular for individuals with cerebral palsy. The suit is also known as Therasuits or Therapy suits and it resembles an outfit that was originally developed by the Russians that helped their astronauts maintain their muscle tone while they were in space.

28. Space Suit Therapy (Continued) The suit has elastic cords that attach to different areas of the body and they are positioned to keep the body properly aligned to forcibly encourage movement within a normal range of motion. The design of the suit causes an individual with cerebral palsy to limit body movement in particular ways in order to force the body into proper physical alignments and help to replace awkward movements with more proper movements.

29. Benefits of Space Suit Therapy Provides proper body alignment which helps improves muscle tone as well as body awareness, gross motor skills and balance. Because the suit helps align and balance the body it also strengthens the body as well.

30. Incorporating Video Games Though more research and studies need to be done, a recent study showed that using a Nintendo Wii for children with cerebral palsy help them improve in different areas including their visual perception, bodily control as well as their functional mobility. If more research shows the same types of consistency, this could be a huge step for helping individuals with cerebral palsy because compared to other types of rehabilitation techniques the Wii is only a fraction of the cost and is commercially produced, which means the individuals could have it in their house and use it on a daily basis.

31. Could malpractice cause cerebral palsy? If a mistake is made during the birth of an infant that was the cause of cerebral palsy doctors as well as nurses can be held accountable. Many doctors and nurses do not know enough about cerebral palsy and this can result in devastating mistakes and lawsuits if a mistake is made. While caring for the expectant mother and fetus, medical providers are responsible for assuring adequate care during the pregnancy, during labor and delivery, and immediately after the delivery of the infant. When injury does occur during the birthing process, the results can be devastating. A cerebral palsy lawyer can help you determine if medical malpractice caused your child's cerebral palsy.

32. Malpractice That Can Result in Cerebral Palsy Leaving the child in the birth canal too long Failure to detect a prolapsed umbilical cord Failure for the doctor to perform a cesarean section (c-section) Failure to respond to the mother’s changing conditions Failure to recognize and treat seizures

33. Something to Keep in Mind In an Australian study, most medical students have a very limited knowledge of cerebral palsy They also have negative attitudes toward individuals with cerebral palsy as a result

34. Legal Information and CT Laws • Cerebral Palsy Lawyers • Haymond Law • http://www.haymondlaw.com/cerebral_palsy/index.asp • A lawsuit may be filed within 2 years from the date of the injury • An expert witness must be present • Must be a doctor who has been licensed and practicing for 5 years • Compensation • There is no limit on the amount of damage award • Limit for Attorney Fees • No more than 1/3 of the first $300,000 • 25% of the next $300,000 • 20% of the next $300,000 • 15% of the next $300,000 • 10% of an award greater than $1.2 million

35. Examples of Lawsuits Cody - Aurora, Illinois – 2001-2002 Mother filed suit against the doctors and hospital because her son was born with brain damage and cerebral palsy The doctor failed to successfully use the vacuum extractor device, which was needed to prevent brain injuries during the delivery The doctors performed an emergency C-section when they realized that the baby’s heart rate was in distress She received $15.35 million for her son’s past and future medical expenses http://www.cerebralpalsysource.com

36. Examples of Lawsuits Hannah - Tennessee The doctors used the wrong instruments when delivering Hannah The nurse and surgical technician failed to follow instructions of the doctor Two doctors at the hospital were in a relationship, which affected morale As a result, Hannah has cerebral palsy Severe brain damage, seizures, developmental delays At age 8, Hannah cannot speak and feels pain when people walk past her http://www.cerebralpalsysource.com

37. Devastating Costs of Cerebral Palsy According to http://www.cerebralpalsysource.com, an “…estimated lifetime expense of living with cerebral palsy is approximately $921,000 a person.”

38. Common Medical Expenses Doctor visits Hospitals Visits to the E.R. Various types of medications Surgeries Rehabilitation Psychological counseling Assistive devices

39. Common Non-Medical Expenses In order for individuals with cerebral palsy to live their lives they need special arrangements that include: Home modifications Vehicle modifications Special education programs Other modified living arrangements to allow mobility

40. Indirect Costs According to http://www.cerebralpalsysource.com, “…indirect costs are considered the limitations a person suffering from cerebral palsy has and the effect on their overall life.” Some of these costs include: Loss of wage The loss of earning potential The inability to provide for or contribute to their life financially, due to severely debilitating conditions Pain and suffering

41. References Cerebral Palsy & Technology. (n.d.). Retrieved March 10, 2009, from http://computers-technology-cerebralpalsy.com Cerebral Palsy @ Brainpalsy.com. (n.d.). Retrieved March 14, 2009, from www.dailymotion.com/video/x68kwh_cerebral-palsy-wwwbrainpalsycom_shortfilms Dolphin Therapy In Kemer Antalya - Turkey - Video. (n.d.). Retrieved March 30, 2009, from http://www.metacafe.com/watch/714493/dolphin_therapy_in_kemer_antalya_turkey/ ExpertHub Inc.. (n.d.). Medical Malpractice Law in Connecticut. Retrieved March 18, 2009, from http://www.lawfirms.com/resources/personal-injury/medical-malpractice/medical-malpractice-law-connecticut.htm French, R. (n.d.). Cerebral Palsy: APE Fact Sheet. Retrieved March 10, 2009, from http://www.twu.edu/inspire/Fact%20Sheets/Cerebral_Palsy.pdf MacLennan, A., Nelson, K., Hankins, G., & Speer, M. (2005). Who Will Deliver Our Grandchildren?: Implications of Cerebral Palsy Litigation. Journal of the American Medical Association, 294(13), 1688-1690. Retrieved March 30, 2009, from the Academic Search Premier database. Martin, H., Rowell, M., Reid, S., Marks, M., & Reddihough, D. (2005). Cerebral Palsy: What Do Medical Students Know and Believe?. Journal of Paediatrics & Child Health, 41(1/2), 43-47. Retrieved March 17, 2009, from the Academic Search Premier database. Infocus Studios, LLC.. (n.d.). Cerebral Palsy & Medical Malpractice Claims. Retrieved March 17, 2009, from http://www.haymondlaw.com/cerebral_palsy/index.asp Rimmer, Ph.D., J. H. (n.d.). Introduction to Cerebral Palsy and Exercise. Retrieved March 18, 2009, from http://www.ncpad.org/disability/fact_sheet.php?sheet=119&view=all&print=yes Winnick, J. P. (2005). Adapted Physical Education and Sport 4th ed.. Champaign, IL: Human Kinetics. eJustice.com. (n.d.). Cerebral Palsy Source. Retrieved March 8, 2009, from http://www.cerebralpalsysource.com