PP08 - Week One

Introduction and Welcome - Introduction to Cerebral Palsy

Welcome to week one of the Managing Children with Cerebral Palsy Course. This week we will focus on developing a good understanding of Cerebral Palsy - what it is, what causes it, what you might expect to see, the impacts it has on posture and movement and what other associated conditions may occur. We will also look at the epidemiology of Cerebral Palsy both within your country and worldwide and examine the role of the interdisciplinary team in managment.

Week One Objectives

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

  • Characterise Cerebral Palsy and describe how the brain influences movement and posture in individuals with Cerebral Palsy
  • Recognise the Global Prevelance of Cerebral Palsy and differences in management around the world
  • Identify other problems that individuals with Cerebral Palsy may face
  • Recognise the importance of interdiscipliary team working with an individual with Cerebral Palsy

Week.1 Video

Let's start this week with an introductory video from Rachael Lowe and ??? who will provide a brief overview of the Managing Children with Cerebral Palsy course and outline what you will cover during this first week of the course.


We know that each child with Cerebral Palsy is unique and every child can be supported to fulfil their individual potential, goals and aspirations. This video from the Cerebral Palsy Alliance in Australia, provides a great start to the course, talks about cerebral palsy, what it is, how it is caused and how it is generally described.

 

Topic 1: Understanding Cerebral Palsy

It is paramount that we firstly have a good understanding of what Cerebral Palsy is in order to manage it effectively. Cerebral Palsy is a disorder of movement and posture that appears during infancy or early childhood resulting from damage to the brain. The damage to the brain is not progressive, but as the child gets older the effects sometimes can become more noticeable, e.g. deformities can develop. Read the Physiopedia page Cerebral Palsy Introduction which examines in detail what Cerebral Palsy is and the effects it has on the individual.

Take a look at this video which reviews the causes, pathophysiology and symptoms of Cerebral Palsy.


Topic 2: Epidemiology

According to Eunson (2012) Cerebral Palsy still remains a common and significant disorder of motor development, with an incidence of 2-2.5 per 1000 live births. Despite improvements in antenatal and perinatal care, there has been little change in the overall numbers of children developing Cerebral Palsy in the last 40 years and with increased survival rates for extremely premature babies more cases of severe forms of cerebral palsy are occurring. 

Read the article by Eunson (2012) on the Aetiology and Epidemiology of Cerebral Palsy as a good understanding of epidemiology is important for planning and managing services for children and young people as well as informing preventative strategies for cerebral palsy through identification of risk factors and trends in prevalence and severity over time.

In many countries and regions, as highlighted by Eunson (2012), Cerebral Palsy Registers are now being used to gain a great understanding of the prevalence of Cerebral Palsy but also assist with research and planning. These registers are databases of clinical information including birth details, type and severity of Cerebral Palsy, associated impairments and parent demographics.

These Cerebral Palsy Registers aim to:

  • Provide accurate and complete information about the number and the needs of children and young people with cerebral palsy for planning services.
  • Monitor changes in the condition over time particularly to see if cerebral palsy is becoming more common or more severe as a result of the increase in small and premature babies now surviving.
  • Allow comparisons with other areas and countries.
  • Support research involving children and young people including studies into functional abilities, quality of life, causes of cerebral palsy and health services research.

Is there a Cerebral Palsy Register in your area? Do you keep a register within your practice of the children you see with Cerebral Palsy in order to plan for future service requirements? Check out list of some of the worldwide CP Registers available.

Topic 3: Associated Conditions

Cerebral Palsy in itself can significantly impact upon the child with many assocaited conditions which also need to be managed. As a Health Care Professional it is essential to also understand these associated conditions and think about how these might impact or influence your management strategies when working with the child. Have a read of this Physiopedia page on Associated Conditions which outlines teh range of conditions often associated with Cerebral Palsy.

Assoc Conditions.jpg

Topic 4: Interdisciplinary Team

In this topic we will understand the importance of working as a team with fellow health care professionals, carers, family and the child. The goal of management of Cerebral Palsy is to increase functionality, improve capabilities, and sustain health in terms of locomotion, cognitive development, social interaction and independence. The best clinical outcomes result from early, intensive management. Optimal treatment in children requires a team approach, which focuses on total individual development, not just improvement of a single symptom.

A variety of healthcare professionals are involved in the provision of care and exchange of information with the child and family members, therefore teamwork is key to coordinate the rehabilitation process and the roles of those involved. It is important to understand the holistic approach to rehabilitation for children with Cerebral Palsy ensuring involvment of the child and family in decision making. Read the Physiopedia page:

According to Hinchcliffe (2007) research has shown that, no matter how expert the treatment, physiotherapy or occupational therapy alone cannot make significant improvement in the condition of a child with Cerebral Palsy. There has to be carry-over from the treatment into the child’s everyday life. As therapists, it is our re- sponsibility not only to help families understand this, but also to enable them to put it into practice.

In the Hinchcliffe Textbook (2007):

  • Read about the Child, Family and Therapist Working as a Team in Chapter 6 pp. 119 - 125

Child-to-Child is an approach to health promotion and community development that is led by children. It is based on the belief that children can be actively involved in their communities and in solving community problems. Child-to-Child projects involve children in activities that interest, challenge and empower them. In so doing, the approach "encourages and enables children to play an active and responsible role in the health and development of themselves, other children, their families and communities". Read the Physiopedia page:

Discussion

Let’s discuss team work in relation to the Management of Children with Cerebral Palsy. What has your experience of team work been in your workplace? Are the child and family part of that team structure?

Tell us something about the team structures within your workplace. Where do the child and family fit in to this structure? What can we do as health professionals to ensure both child and family member involvment within that team? Go to discussion

Reflection

As clinical practitioners it is important that we clinically reflect upon our learning experiences. Use this introduction to clinical reflection to help you with this task.

For example use the What, So What, What Now reflective framework 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. We will be sharing our reflections in the discussion forum. Go to discussion

Additional Resources

The following optional resources have been gathered for you to read / view to expand your knowledge further on this week’s topics.

1. Introduction to Cerebral Palsy. Module 1 In: Getting to know Cerebral Palsy: A Learning Resource for Facilitators, Parents, Caregivers and Persons with Cerebral Palsy. Hambisela Project

2. Susan Stott. Cerebral Palsy. Chapter 8 In: Rome K, McNair P, editors. Management of Chronic Musculoskeletal Conditions in the Foot and Lower Leg. Elsevier Health Sciences; 2014 Sep 18.

3. What is Cerebral Palsy and How Does it affect Children? Chapter 1 In: Hinchcliffe A. Children with Cerebral Palsy:

    A Manual for TherapistParents and Community Workers. SAGE Publications India; 2007 Feb 6

  • Chapter.1 What is Cerebral Palsy and How Does it affect Children?

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

  • Chapter.1 Communication Between Parents and Professionals. 
  • Chapter.3 Medical Aspects of Cerebral Palsy.
  • Chapter 6 Parent’s Problems.

5. Shepherd RB. Cerebral Palsy in Infancy. Elsevier Health Sciences; 2013 Sep 20

  • Part 1: 1. Changing Face of Interventions in Infants with Cerebral Palsy, pp 12-18
  • Part 2: 3. Re-thinking the Brain: New Insights into Early Experience and Brain Development, pp 76-79
  • Part 3: 4. Functional Effects of Neural Impairments and Subsequent Adaptations, pp 90-975
  • Part 3: 5. Syndrome of Deforming Spastic Paresis: Pathophysiology, Assessment & Treatment, pp 118-126
  • Part 3: 6. Skeletal Muscle Changes due to Cerebral Palsy, pp.135-142
  • Part 3: 7. Early Muscle Development in Children with Cerebral Palsy: Consequences for Further Muscle Growth, pp 157-169

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