INTRODUCTION
While cerebral palsy is a blanket term commonly referred to as “CP” and described by loss or impairment of motor function, cerebral palsy is actually caused by brain damage. The brain damage is caused by brain injury or abnormal development of the brain that occurs while a child’s brain is still developing — before birth, during birth, or immediately after birth.
Cerebral palsy affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture and balance. It can also impact fine motor skills, gross motor skills and oral motor functioning.

Those with cerebral palsy were most likely born with the condition; although some acquire it later. It was once thought that cerebral palsy was caused by complications during the birthing process. While this does happen, it is now widely agreed that birthing complications account for only a small percentage, an estimated ten percent, of cerebral palsy cases. In my interview with Mrs. Rachel Kagichiri, a parent to a recently diseased CP child, she explained to me that many of the misconceptions we have about the disease should be done away with. Karanja, her son, was often blamed on her ‘negligence’ by relatives and friends who openly thought she must have done something for her son to turn out this way.
Current research suggests the majority of cerebral palsy cases result from abnormal brain development or brain injury prior to birth or during labor and delivery. Accidents, abuse, medical malpractice, negligence, infections, and injury are some known risk factors that may lead to cerebral palsy.

An individual with cerebral palsy will likely show signs of physical impairment. However, the type of movement dysfunction, the location and number of limbs involved, as well as the extent of impairment, will vary from one individual to another. It can affect arms, legs, and even the face; it can affect one limb, several, or all.
Cerebral palsy affects muscles and a person’s ability to control them. Muscles can contract too much, too little, or all at the same time. Limbs can be stiff and forced into painful, awkward positions. Fluctuating muscle contractions can make limbs tremble, shake, or writhe.
Balance, posture, and coordination can also be affected by cerebral palsy. Tasks such as walking, sitting, or tying shoes may be difficult for some, while others might have difficulty grasping objects. Other complications, such as intellectual impairment, seizures, and vision or hearing impairment also commonly accompany cerebral palsy.

Every case of cerebral palsy is unique to the individual. One person may have total paralysis and require constant care, while another with partial paralysis might have slight movement tremors but require little assistance. This is due in part by the type of injury and the timing of the injury to the developing brain.

Cerebral palsy is non-life-threatening – With the exception of children born with a severe case, cerebral palsy is considered to be a non-life-threatening condition. Most children with cerebral palsy are expected to live well into adulthood.
Cerebral palsy is incurable – Cerebral palsy is damage to the brain that cannot currently be fixed. Treatment and therapy help manage effects on the body.
Cerebral palsy is non-progressive – The brain lesion is the result of a one-time brain injury and will not produce further degeneration of the brain.
Cerebral palsy is permanent – The injury and damage to the brain is permanent. The brain does not “heal” as other parts of the body might. Because of this, the cerebral palsy itself will not change for better or worse during a person’s lifetime. On the other hand, associative conditions may improve or worsen over time.
Cerebral palsy is not contagious; it is not communicable – In the majority of cases, cerebral palsy is caused by damage to the developing brain. Brain damage is not spread through human contact. However, a person can intentionally or unintentionally increase the likelihood a child will develop cerebral palsy through abuse, accidents, medical malpractice, negligence, or the spread of a bacterial or viral infection.
Cerebral palsy is manageable – The impairment caused by cerebral palsy is manageable. In other words, treatment, therapy, surgery, medications and assistive technology can help maximize independence, reduce barriers, increase inclusion and thus lead to an enhanced quality-of-life.
Cerebral palsy is chronic – The effects of cerebral palsy are long-term, not temporary. An individual diagnosed with cerebral palsy will have the condition for their entire life.

The cause of cerebral palsy is brain injury or brain malformation that occurs while the brain is developing — before, during, or after birth. Cerebral palsy affects muscle control, muscle coordination, muscle tone, reflex, posture and balance. It can also impact fine motor skills, gross motor skills and oral motor functioning.
Every case of cerebral palsy is unique to the individual. This is due in part by the type of injury and the timing of the injury to the developing brain. The brain damage that causes cerebral palsy is a result of either: * Prenatal disturbance of brain cell migration - Genetic and environmental factors disturb brain cell migration as cells move to their appropriate location during brain development. * Prenatal poor myelination (insulation) of developing nerve cell fibers – Brain function is impeded when poor myelin provides an inadequate protective covering over nerve cells that aid in transmission. * Prenatal brain cell death – Events in the birthing process that rupture blood vessels or starve oxygen to the brain. * Postnatal non-functional or inappropriate connections (synapses) between brain cells – Trauma, infections, and asphyxia that damage connections developed in the brain.

PHYSICAL AND DEVELOPMENTAL SYMPTOMS OF CEREBRAL PALSY

Signs of cerebral palsy are different than symptoms of cerebral palsy.
Signs are clinically identifiable effects of brain injury or malformation that cause cerebral palsy. A doctor will discern signs of a health concern during exam and testing.
Symptoms, on the other hand, are effects the child feels or expresses; symptoms are not necessarily visible.
Impairments resulting from cerebral palsy range in severity, usually in correlation with the degree of injury to the brain. Because cerebral palsy is a group of conditions, signs and symptoms vary from one individual to the next.
The primary effect of cerebral palsy is impairment of muscle tone, gross and fine motor functions, balance, control, reflexes, and posture. Oral motor dysfunction, such as swallowing and feeding difficulties, speech impairment, and poor muscle tone in the face, can also indicate cerebral palsy. Associative conditions, such as sensory impairment, seizures, and learning disabilities that are not a result of the same brain injury, occur frequently with cerebral palsy. When present, these associative conditions may contribute to a clinical diagnosis of cerebral palsy.
The most common early sign of cerebral palsy is developmental delay. Delay in reaching key growth milestones, such as rolling over, sitting, crawling and walking are cause for concern. Practitioners will also look for signs such as abnormal muscle tone, unusual posture, persistent infant reflexes, and early development of hand preference.
Many signs and symptoms are not readily visible at birth, except in some severe cases, and may appear within the first three to five years of life as the brain and child develop.
If the delivery was traumatic, or if significant risk factors were encountered during pregnancy or birth, doctors may suspect cerebral palsy immediately and observe the child carefully. In moderate to mild cases of cerebral palsy, parents are often first to notice if the child doesn’t appear to be developing on schedule. If parents do begin to suspect cerebral palsy, they will likely want to consult their physician and ask about testing to begin ruling out or confirming cerebral palsy or other conditions.
Most experts agree; the earlier a cerebral palsy diagnosis can be made, the better. However, some caution against making a diagnosis too early, and warn that other conditions need to be ruled out first. Because cerebral palsy is the result of brain injury, and because the brain continues to develop during the first years of life, early tests may not detect the condition. Later, however, the same test may, in fact, reveal the issue.
If a diagnosis can be made early on, early intervention programs and treatment protocols have shown benefit in management of cerebral palsy. Early diagnosis also helps families qualify for government benefit programs and early intervention.
Since cerebral palsy is most often diagnosed in the first several years of life, when a child is too young to effectively communicate his or her symptoms, signs are the primary method of recognizing the likelihood of cerebral palsy.
Cerebral palsy is a neurological condition which primarily causes orthopedic impairment. Cerebral palsy is caused by a brain injury or brain abnormality that interferes with the brain cells responsible for controlling muscle tone, strength, and coordination. As a child grows, these changes affect skeletal and joint development, which may lead to impairment and possibly deformities. The eight clinical signs of cerebral palsy involve: * Muscle Tone * Movement Coordination and Control * Reflexes * Posture * Balance * Fine Motor Function * Gross Motor Function * Oral Motor Dysfunction
In some instances, signs become more apparent when the child experiences developmental delay or fails to meet established developmental milestones. * Developmental Delay * Developmental Milestones

PSYCHOLOGICAL AND SPIRTIUAL EFFECT OF CEREBRAL PALSY

Cerebral palsy is definitely a straining condition on the psychology of the parent and the child. Therefore behavioral therapy is often advised as this eases the load the parents and caregivers have to carry.
For parents, learning their child has a brain injury and resulting physical impairment can be an overwhelming and life-altering event. This often results in anger towards God and sometimes a deep resentment for the child is experienced. The Kagichiris were no different in this regard. Wathugi Kagichiri, Karanja’s elder brother disclosed the extreme disappointment he felt on learning that his brother would never be able to lead a normal life. Currently, two members of the Kagichiri family are atheists as the pain and anguish Karanja went through does not connect with a loving caring God to them. Substantial financial resources may be required as participation in intensive treatment planning begins. Family relationships may become strained, daily routines may be modified, and hopes and plans for the child’s future may be altered. These are only a few changes a family may experience, but there is hope. Accepting the diagnosis, managing the child’s treatment regimen, and becoming a positive influence on the child’s development can be achieved through behavioral therapy.

In early childhood, emotional, social, attentive and behavioral skills are developing. These learned behaviors influence adulthood. Early on, a child begins to label feelings, understand and express emotions, develop sympathy, care, and react to others. The child’s immediate family as well as friends, teachers and caregivers influence his or her learned behaviors. Emotionally healthy children are provided opportunities to interact with others, develop meaningful friendships, and socialize to their greatest capacity. When a child shows signs of difficulty with play, learning, interacting, or performing, he or she (and, in some cases, the child’s support system) may benefit from screens, evaluations, problem identification, interventions, or focused instruction rendered by those trained in behavioral therapy.
During different stages in the child’s life, and dependent upon the level of severity, a child with cerebral palsy may feel ostracized by peers, frustrated with treatment goals, isolated from friendships, embarrassed by medical conditions – incontinence or drooling, for example – and saddened when limited by his or her own abilities. In some cases, the child may be unable to communicate in conventional ways.
When these issues arise, a child is best served by therapies that will help acquire a healthy attitude toward his or her challenges and progress. Behavioral therapy can release depression, mood swings, sadness, loss, anger and frustration, allowing previous negative outcomes to be replaced with empowerment, encouragement, coping skills, alternative interventions, perspective energy, and improved quality-of-life. Behavioral therapy is even beneficial in conjunction with physical therapy to encourage and reward desired outcomes and discourage negative behaviors and thoughts towards tasks.
When a child with cerebral palsy is unable to communicate, a wealth of emotion can become pent up inside, especially if the child is not able to ask for assistance, express pain, socialize with peers, or interact with health care providers. Behavioral therapy seeks ways that will allow the child to interact with their environment and gain control over their emotions. They may employ adaptive equipment or communication devices tailored to meet their specific abilities. Once a child is able to communicate, he or she is more able to enjoy life activities, bond with family and friends, improve academics, participate in care, and contribute more fully during treatment. Increased quality-of-life and the ability to communicate has been proven to be an important factor in a child’s lifespan.
A child with cerebral palsy who also has intellectual impairment may have difficulty performing every day skills required for self-care, hygiene, and within societal norms. Intellectual and cognitive impairment is present in two-thirds of those with cerebral palsy. A below average IQ will affect the ability to learn, focus, and socialize. A child in this situation may begin to feel isolated, underperforming, different, and excluded by peers. Behavioral therapy can assist the child with overcoming feelings of inadequacy and meaninglessness. These feelings will be replaced by building their own values, self-worth, and accomplishment. They will sort through their emotions, obtain communication skills, and feel better about themselves and their interactions. With healthy relationships and bonding the child will gain purpose and fulfillment.
When a child transitions into adulthood many life-altering changes may occur. The individual is no longer guided by the education system, therapies and treatment may have decreased, and he or she is more focused on living as independently as possible. This can be a frightening time. The focus is to concentrate on self-care, provide for future needs, work, remain physically active, and socialize. Behavioral therapy can help empower, focus, and affect life-changing circumstances. With behavioral therapy the adult can obtain a “can-do” attitude, dream, and visualize the future.

For the caregiver, behavioral therapy provides an education and tools to identify at-risk and self-sabotaging behaviors in his or her own, as well as the child’s behavior. Through therapy, a caregiver will learn to recognize attention disorders, identify stressors, prevent meltdowns, remove triggers, and positively affect behaviors. Behavioral therapy educates and empowers caregivers to influence a child’s progress.
Benefits may include development of a consistent behavioral management plan, reward system, positive interactions, and adaptation techniques to fit the child’s ability levels. For instance, classic games can be adapted to a child’s ability level, a Dynavox can be purchased to assist in communication, and other family members can use adaptive equipment when racing or playing basketball to match the child’s abilities.
Parents, caregivers and children with cerebral palsy can all benefit from the positive interactions achieved with behavioral therapy to compassionately, respectfully, and appropriately interact with each other in a stable, secure and happy environment.

The child and/or family may benefit from behavioral therapy if a quality-of-life – for the child or family members – is compromised or behavior is affecting others. Behavioral therapy can also be helpful if the child may be penalized to the extent they are restricted from socializing with others; when they disrupt others from learning in an educational environment; or when they are not bonding with family. It can also become useful when the child’s peers act in such a way to bully the child into irritability, isolation, rejection, or depression.
Sometimes a child will act in a manner that affects those around them. This can happen in situations where attention-deficit disorder causes disruptions to the class or the teacher’s ability to instruct. It could also occur at times when the child is so frustrated they pinch, hit, or act out against those around them. If they cause harm to others, or are deemed to be a possible threat to themselves, they could benefit from behavioral therapy.
Signs to look for in the child include: * Anger * Aggression * Anti-social behaviors * Anxiety * Appetite loss * Change in sleep patterns * Depression * Difficulty in performing tasks * Distress * Feelings of helplessness * Frustration * Irritability * Isolation * Loss of interest * Low academic performance * Moodiness * Peer rejection * Social-emotional deficiencies * Whining

REFERNCES
Daughter: A Life With Cerebral Palsy, Thomas Publishers
Mark Stewart Jones

Infantile Cerebral Palsy, Whetstone Publishing House
Grace E. Woods

"The Sometime Physician": William John Little, Pioneer In Treatment Of Cerebral Palsy And Orthopedic Surgery (1810 1894), Aquarian Systems
Jay Shieckholm

Cerebral Palsied and Learning Disabled Children: A Handbook/Guide to Treatment, Rehabilitation, and Education, Thomas Publishers
Nancy C. Marks Published August 28th 1974 (first published 1974)

CEREBRAL PALSY
LUMIERE WANJIRU NGIGI
(11-0718)
Presented to:
Ms. Caroline Ayuya
In partial fulfillment of the course
PSY211T
DAYSTAR UNIVERSITY
8TH MARCH 2013