Cerebral palsy affects children, adolescents, and adults who struggle with difficulty or inability to execute voluntary movements and maintain posture. These limitations stem from brain injury sustained before, during, or shortly after birth.
These pages on cerebral palsy do not pretend to exhaust the vast medical, social, and educational problems posed by such a serious handicap. Rather, they aim to help us open the door that separates us from people so often unjustly isolated by our hesitation to understand their world with courage and without false sentimentality.
Once incurred, this brain injury affects development in ways that, though persistent, may worsen or improve depending on age, therapy, living conditions, and other factors.The impairment ranges from mild cases detectable only by a physician to severe conditions that confine the child, adolescent, or adult to a wheelchair or bed.
Often present from birth, this condition is never hereditary.
The motor difficulties that form the core of the disease alter posture, gait, the gestures of daily life, and sometimes speech itself.
These difficulties arise in varying proportions from:
1) paralysis with muscle stiffness (spasticity) that risks causing muscle atrophy and deformities of the limbs and trunk;
2) coordination disorders (lack of harmony in movement) sometimes accompanied by involuntary movements (athetosis);
3) balance disorders (ataxia).
- According to the location of motor damage, we distinguish:
Little's diplegia (lower limbs affected) - hemiplegia (upper and lower limbs on the same side affected)
- tetraplegia (all four limbs and trunk affected).
By the nature of the disorder, we may distinguish: the spastic types, who have difficulty moving and are prone to orthopedic deformations; the athetoid types, who have great difficulty with balance and suffer from disorderly gesticulation and speech impairment; and the ataxic types, who have uncertain gait that causes frequent falls usually without serious consequence.
In reality, each person with cerebral palsy is a particular case in which the restrictive elements mentioned above are mixed in variable ways, but to which associated disorders are added whose importance is sometimes essential for treatment and prognosis: these often include intellectual disability or epilepsy.
Sensory disorders—visual or auditory (the latter in athetoid cases)—as well as emotional or behavioral difficulties may also be observed.
Assessment of intelligence sometimes poses difficult technical problems, particularly when speech is unintelligible and gestures poorly controlled. Yet such assessment is almost always possible, and rehabilitation and schooling depend upon it.
In fact, those with cerebral palsy of relatively good ability and an intelligence quotient above 65 make up at most one-third of those affected: for them, physical therapy offers the most encouraging results, and schooling proves possible despite numerous obstacles in learning to read and especially to write—obstacles that proper techniques and equipment can help reduce.
Motor rehabilitation employs global methods aimed at neuromotor reorganization. It must also prevent bodily deterioration and worsening orthopedic deformations through analytical maneuvers. In any case, the effort is to develop functional autonomy as much as possible, even if this must be achieved through procedures sometimes very different from those used in normal development.
This adaptation of the handicapped person to their handicap also draws on the contribution of speech therapists and occupational therapists and relies—when necessary—on orthopedic devices and surgical interventions whose indications are difficult to determine and must always remain measured.
Because of motor deficits, particularly those affecting the hands—which limit not only mobility but especially job possibilities—many parents direct their children or adolescents toward "intellectual" activities they rarely can achieve, with poor integration as a result. It will often be necessary, then, to restrain the tendency toward higher-level schooling that may harm the development of these young handicapped people's personalities. Instead, despite motor difficulty and using technical aids or workplace adaptations when needed, we should try to find activities that can interest them and, if possible, allow them to experience the satisfaction of creative work.
- by Roger Salbreux
(from Ombres et Lumière, no. 47)
