Module 2: Evaluating your Child
When you have finished this workshop, you should:
- have a clearer understanding about development in children and be able to explain this to someone else.
- You should be able to observe a / your child with cerebral palsy, and show where on the development chart she is.
- You should be able to show which activities could be suitable for a / your child to learn next.
Now think about other children in your family, or in your neighbourhood. Think about what skills they first learnt as they grew and developed?
Now look at these four sentences that talk about different types of skills.
- Self-care activities such as eating, dressing, toileting
- Moving around from place to place
- Walking (if possible)
Being able to communicate in some way with others, allows us to have and build a relationship with them. A child with a disability can learn to help with self-care skills even if she is not able to move around from place to place, or walk.
ALL children have the potential to learn and develop these skills through a sequence of steps.
BUT, each child will learn and develop at her own pace and in her own way.
Before you can look at how your child has developed, we need to understand how development usually happens. These pictures show the sequence in which children usually develop some of their movements.
But children don’t just develop their muscles, or movements, they also develop in communication, in their social and emotional skills like selfcare activities and relating to others, and in their thinking and playing. This development will carry on, unless something happens or is missing to stop or slow the development.
These skills include:
Movement: Large muscles for sitting, standing, walking, running. Small muscles for pointing, picking up things, feeding self, enjoying water and sand, feeling objects etc
Communication: Using language or signs of some kind so others can see what you need or
feel. Communication is not just talking.
Social and emotional skills: Self-help skills – being able to eat, drink, use the toilet or show
you need to do these, and assisting the caregiver. Being part of a group, having relationships,
feelings, how you behave.
Thinking and playing: Understanding what things mean, learning how things work, learning
the names of things, understanding how to do things. Children mostly do this by playing.
How Learning Takes Place
Next time you see a baby learning to stand, or crawl, or handle an object with her hands, watch her. Watch how long she spends practicing. And watch how many times she repeats it. We all know the saying: practice makes perfect. Well, that’s what babies do all the time…
Babies practice by doing the same activity over and over and over again until they get better at it. But we have also learned that a baby or child with cerebral palsy has damage to areas in her brain, and therefore may not be able to move by herself, or perhaps only with great difficulty. Or maybe when she does try to move by herself, her tongue or limbs or head keep going into really difficult positions.
Can you think how you have seen your baby / child trying to do things?
And what happens? So what does a baby / child need?
HELP TO PRACTICE
So she can’t practice by herself. That is why development in a child with cerebral palsy is slowed, or blocked, or seems to be stopped. If your child has difficulty practicing on her own, you will have to help her practice, over and over again. This diagram of a bean plant illustrates the development of a child.
Think about how plants grow and develop:
Have you ever grown a plant? Was it easy?
What did the plant need in order to grow?
Many plants need help to grow and develop well. Just as the plant needs water to help it grow, so your child needs your help in order to grow and develop well.
Have you seen a plant tied to a stick when it’s young?
What is the purpose of the stick?
Just as some plants need a stick to help them to grow up straight, so your child may need assistive devices like a buggy or a wheelchair or a standing frame to help her to be in a good position so that she can learn to use her muscles and help them to grow and develop well.
do. When you have finished, the chart should show where your child fits in each row.
HINT: It is possible and likely to get ticks in one row more or less advanced than ticks in another row. So do not go with what the age of your child is and where you think they should be, but with WHAT YOU CAN SEE THAT YOUR CHILD CAN DO, OR IS TRYING TO DO, OR WANTS TO DO.
You can get other members of your family, or community, to help you with this. Do it over a number of days or different periods of observation. If you take your child for therapy, you might like to take the chart with you and discuss it with the therapist. Remember, there is no right or wrong. You are building up a picture of where YOUR child is with her development.
The development chart shows you as parent / caregiver, in a clear and ordered way:
- What the can do
- What the chid cannot do
- What that child is just beginning to do or trying to do
- Which activities can be tried next with the child
- How to mark the child's progress
Now look at the child’s chart, and mark on it which activities you plan to try with her next. Can you link these with the goals and hopes you have for the child? You may like to discuss these with a therapist / family too, if possible. Encourage her to keep on doing it by herself, rather than you doing it for her. Or just give her the help that she may need. These pictures show an example of how to do this:
Sources and Resources
Ideas from many sources have helped us to develop the Hambisela programme. The following material and references have been particularly helpful, either as sources or as inspiration on how to present training, and we gratefully acknowledge their use. In many cases we have been given permission to use photographs. Where permission could not be obtained, the faces have been re-touched in order to protect identity.
- Disabled Village Children – A guide for community health workers, rehabilitation workers, and families, David Werner, The Hesperian Foundation, Berkeley (1999).
- Promoting the Development of Young Children with Cerebral Palsy – A guide for mid-level rehabilitation workers, World Health Organisation, Geneva (1993).
- Let’s Communicate – A handbook for people working with children with communication difficulties, World Health Organisation, Geneva (1997).
- Community Based Rehabilitation -- Training and Guide, World Health Organisation, Geneva (1989).
- Cerebral Palsy, ga se boloi (it’s not witchcraft), Physiotherapist Department of Gelukspan Center, Reakgona.
- Polokwane Hospital CP Group Manual, Polokwane Hospital.
- Community-Based Rehabilitation Workers – a South African training manual, Marian Loveday, SACLA Health Project, Cape Town (1990).
- Foden Manuals 1-4, Foden Centre, East London (1999).
- Practicing the new ways of feeding your child at home, Diane Novotny, Speech, Language and Feeding Therapist, Western Cape CP Association & Red Cross Children’s Hospital, Cape Town (circa 2006)
- Learning for Life, Masifunde 2002, Staff Development Special Care Centres, Cape Mental Health.
- The Education of Mid-Level Rehabilitation Workers, World Health Organisation, Geneva (1992).
- Disability Prevention and Rehabilitation in Primary Health Care – A guide for district health and rehabilitation managers, World Health Organisation, Geneva (1995).
- Disability Prevention and Rehabilitation – A guide for strengthening the basic nursing curriculum, World Health Organisation, Geneva (1996)