PP08 - Week Four

Introduction to Week Four - Communication and Feeding

Welcome to week four of the Managing Children with Cerebral Palsy course. This week we will explore communication with the child with cerebral palsy and their parents. We will also look at some of the difficulties that a child with cerebral palsy may experience during feeding and how to manage these.

Week Four Objectives

By the end of this week you should be able to:

  1. Recognise why it is so important to address communication with the child with Cerebral Palsy
  2. Describe and teach methods to help children with Cerebral Palsy communicate
  3. Explain the difficulties that a child with cerebral palsy may experience during feeding
  4. Describe methods to improve feeding experience and independence
  5. Recognise the links between feeding and communication

Week Four Video

To start week two watch this introductory video with Rachael Lowe and ........

VIDEO

Interview with Speech Therapist......

Topic 1: Communication

Communication occurs when a sender transmits a message and a receiver understands the message. An effective communicator independently alternates as a sender and a receiver regardless of the demands of a conversation, including settings, conversational partners, and topics.

 [1]

The Physiopedia page Communication and Children with Cerebral Palsy examines the various methods of cummication and challenges faced by children with Cerebral Palsy. 

Movement plays a key role in Communication, from the early facial expressions and limb movements of a young child that are interpreted by carers as having meaning, to the intricate and complex oral-motor movements involved in the production of speech. Therefore, Cerebral Palsy can have significant consequences for the development of communication. In Finnie Textbook (2009):

  • Read about Communication in Chapter.18 pp. 227 - 242, which examines how cerebral palsy can affect communication skills and reviews some of the communication methods available.

According to Finnie (2009) it is universally recognised that parents play a key role as educators of their child, especially during the early formative years. Children with Cerebral Palsy are just as dependent on this early learning/interaction, but the movement disorder and abnormal responses may often interfere with the natural process, creating barriers to learning basic communication skills. The Finnie Textbook (2009) examines the Parents’ contribution to early learning, particulalry in relation to developing a dialogue using touch, sight, hearing and communication. 

  • Read about Parents Contributions to Communication in Chapter. 9 pp. 95 - 99, which examines how a child learns and the importance of touch, sight, hearing and communication is that process.

Watch this video by Novita Childrens Services, where Speech and Language Therapists and Parents discuss the importance of communication therapy in the lives of children with Cerebral Palsy.

 [2]

The Communication Function Classification System (CFCS) for Individuals with Cerebral Palsy was developed as a tool to classify the everyday communication performance of an individual with cerebral palsy into one of five levels. The CFCS focuses on activity and participation levels as described in the World Health Organization’s ( WHO) International Classification of Functioning, Disability, and Health (ICF). While originally developed for use with individuals with Cerebral Palsy, the CFCS is now being used to describe communication performance of individuals with any disability.

Topic 2: Feeding

Feeding is extremely important for the development of the motor and cognitive functions = food is essential nourishment for brain development. In this topic we will look at feeding and the process of feeding. We will then examine in detail the feeding difficulties experienced by some children with Cerebral Palsy. Read the Physiopedia Page on Feeding and the Swallow Mechanism so that you have a good understanding of the processes involved with feeding in a child without feedding difficulties.

Dysphagia is a condition in which disruption of the swallowing process interferes with a patient's ability to eat and drink. But it should be seen in a more wide prospective including the huge impact that this problem has on the social/family interaction and on the personal/emotional status of the child. Therefore the treatment approach should not focus only to biomechanically make feeding safely possible but also should consider the emotional aspect of eating (pleasure, social moment etc.). Read the Physiopedia Page 

Watch this video by Novita Childrens Services, where Speech and Language Therapists, Nutritionists and Parents discuss the importance of nutrition and feeding therapy in the lives of children with Cerebral Palsy.

Kuperminc et al (2013) examine the best practices around the nutritional management of children with cerebral palsy and provide a set of simple, practical suggestions to enable improved managment of these complex and challenging needs.

If you want to learn more specifics in relation to Managing Mealtimes the New South Wales Government Family & Community Services have developed and online course which will build your understanding of good practice in assessment and intervention when supporting a person with a disability at mealtimes. It illustrates the person-centred nature of mealtimes and outlines how to promote active participation. There are 12 interactive modules which cover a wide range of topics focused on the person with mealtime issues.

Topic 3: Thinking about Adulthood

At this stage in the course we should start thinking about what happend as the child ages. The majority of individuals with Cerebral Palsy will have a similar life expectancy to individuals without impairment. At this stage in the course we should start thinking about what happend as the child ages. The majority of individuals with Cerebral Palsy will have a similar life expectancy to individuals without impairment. The main factors for life expectancy in Cerebral Palsy are gross motor function and feeding difficulties. Individuals who are independently ambulant and able to feed independently have life expectancies in the normal range.

Padraic Moran talks about growing up with Cerebral Palsy and making the transition from school to College and then work. Padraic has Spastic Quadriplegia, uses Elbow Crutches for Gait and a Powerchair for longer journeys. He gives some greater insight into some of the difficulties faced by individuals with Cerebral Palsy, the importance of both equipment and support strictures for independance and has some great advice for both Healthcare Professionals and other Individuals with Cerebral Palsy on managing the transition to adulthood.

[Video Padraic Moran]

Read the Physiopedia Page on Cerebral Palsy thourgh the Lifespan which takes a look at Cerebral Palsy through the different stages of life, and discusses some of the changes that may occur in individuals with Cerebral Palsy with ageing.

Although the brain injury that initially causes Cerebral Palsy by definition does not progressively worsen through the lifetime, the effects of Cerebral Palsy do manifest differently through-out the lifespan. Read the 

Moll & Cott (2013) examine the experience from the perspective of individuals growing up and growing older with Cerebral Palsy. All who took part in the study told stories of access to extensive rehabilitation as a child, followed by a reduction to access to rehabilitation during adolescence to finally little to no access for rehabilitation in adulthood, despite declines in the functional abilities which threaten their ability to participate in daily life and continue to fulfill the roles and responsibilities associated with work, social, family and leisure.  (Optional)

Quiz

1. Which type of visual stimulation you will use with a baby 1-4months old?

  • First mother/father face 20cm distance, some weeks after black and white objects will attract more to the baby.
  • First mother/father faces 21cm distance, after shaking quickly objects with lights and bright yellow.
  • Bright colorful objects would attract the newborn.
  • The newborn cannot see anything until 3-4 months

2. At what age in the normal development the child recognizes his own name?

  • 2 months
  • 16 months
  • 4-6months
  • 2 years

3. What advices would you give to a mother of a 9 month old baby who has a strong startle response with sudden noises or movements?

  • Gently repeat his name very often
  • Use a soft tone of voice
  • Give him a toy with sound and lights
  • Sing a song to him

4. Around 8 to 10 months the kids become wary of strangers.

  • True
  • False

5. How can a PT or speech therapists try to avoid the bite reflex and his consequences in a CP child?

  • Putting the child in supine position, so she/he cannot bite the spoon
  • Flexion and controlled position and desensitizing programs
  • Using a plastic and a correct size spoon
  • Using only cups

6. The aim of aided communication using an object is to:

  • Let the child grasp the object and put it in the mouth
  • Start to pronounce the name of the object
  • Associate the object to what is going to happen

7. As a general rule for communication, gesture should be used without spoken language.

  • True
  • False

8. If parents of a 3 years old with Cerebral Palsy child tell you that the refusal to eat is one of the most important problem, you would:

  • Check for signs of gastroesophageal reflux
  • Tell the parents to change type of food until they will find what the child most like and continue to use only that
  • Tell them to start the syringe feeding as soon as possible
  • Do an evaluation of the feeding
  • Start with oral motor stimulation at first

9. What percentage of adults with Cerebral Palsy reported deterioration in ambulation.

  • 25%
  • 44%
  • 60%
  • 75%

10. What percentage of adults with Cerebral Palsy experience chronic daily pain?

  • 15%
  • 28%
  • 73%
  • 82%

Case Study

This week all we would like you to do is take a look at this case study, read the information before you watch the video and as you watch the video start to engage your observation skills. Marwan spends most of her time in the home in a corner of the sofa, in front of the televisions. Her main social interactions are with the parents and her siblings with her main communication being non-verbal. She is very thin and has difficulties to control her saliva, with the consequence that she is drooling (and her mouth is open) most of the time and is regularly affected by bronchitis. Feeding has become quite a negative experience for Marwan, who crys and becomes aggressive around feeding. She was breastfed until 2 years of age, is now being bottle fed and taking some yogurt with spoon but will never actively look for food.

What do you see as being the main feeding difficulties that Marwan has during feeding? What advice and support would you give to Marwan's parents to improve the feeding process making it both a more positive process for parent and child but also to improve Marwan's nutritional status and ensuring she gets adequate levels of nutrition for growth and development. 

Communication is also key for Marwan's developmnet, what activities, attitudes and behaviour in relation to communication could you encourage her parents to use to develop Marwan's communication with both the family and those outside the family longer term. 

View the Week Four Case Study - Marwan

Discussion

As we have seen from this week's topic both communication and feeding can be quite complex and varied depending on the impairments of the child with Cerebral Palsy. When we look at both these areas what role do you think physiotherapy plays in supporting the child in the development of communication and feeding? How can we promote this through our interventions and in working with parents? 

When developing communication skills is consistency in approach between home, school and therapy a key compnent to encouraging the child to develop their skills and confidence in communication. What are your throughts given what you have learned this week?

Reflection

As usual we would like you to reflect on your learning, use one of the reflective frameworks to write a short reflection on what you have learnt this week and how you plan to implement this new knowledge in your future practice. Share this reflection in the discussion forum. Go to discussion

Additional Resources

Books

Finnie NR. Handling the Young Child with Cerebral Palsy at Home. Elsevier Health Sciences; 1997.

  • Ch. 13 Feeding, pp 149-165

Hinchcliffe A. Children with Cerebral Palsy: A Manual for Therapists, Parents and Community Workers. SAGE Publications India; 2007 Feb 6

  • Chapter 9 Assessment and Management of Eating and Drinking Difficulties

Ruth Kent. Handbook of Clinical Neurology, Vol. 110 (3rd series) Neurological Rehabilitation

  • Chapter 38 Cerebral Palsy

Training Resources

Let's Communicate: A Handbook for People Working with Children with Communication Difficulties. WHO. (1997).

  • Section 1 Communication
  • Section 5 Cerebral Palsy

Hambisela. Getting to Know Cerebral Palsy: A Learning Resource for Facilitators, Parents, Caregivers, and Persons with Cerebral Palsy Version.3. Cerebral Palsy Association (Eastern Cape); 2010

  • Module 4 Communication
  • Module 6 Feeding

Articles

Clinical Practise Guidelines

  • Cerebral Palsy Clinical Practice Guidelines CP-CPG. Waikato District Heath Board. 2014 Ch. 6 Communication, pp 93-121

Websites

Videos


Camila Goes to

Feeding Therapy

Feeding Therapy  

"Its Not Just About Swallowing"

Mason Zayid

99 Problems but Palsy is not One

  1. Centre for AAC - University of Pretoria. The Power of Augmentative and Alternative Communication. Available at: https://www.youtube.com/watch?v=FeNvhuw2TEI (Accessed 9 September 2016).
  2. Nova Childress Services. Communication: children with cerebral palsy. Available at: https://www.youtube.com/watch?v=6soIIOco-zs (Accessed 9 September 2016).