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Cerebral Palsy and Children with Vision and Hearing Loss

By Stacy Shafer, Early Childhood Specialist & Kate Moss, Family Support Specialist, TSBVI, Outreach

What is Cerebral Palsy?

Cerebral Palsy or CP is a condition that is mainly characterized by an inability to fully control motor function. This may include muscle tightness or spasm, involuntary movement, and/or disturbance in gait and mobility. It is NOT a disease, is not communicable, and is not progressive. It is caused by damage to the brain, rather than muscles. This damage can occur before, during or shortly after birth. Lack of oxygen, illness, poisoning, and head injury are some factors that can cause cerebral palsy.

People who have CP may also experience a range of conditions in addition to impaired motor function. These may include:

CP can range from very mild to very severe. No two people are affected in exactly the same way. Some children with mild CP may not be diagnosed until after they are two years old.

There are three main types of CP:

It is important to note that these three types of CP may also occur in various combinations.

Physical therapists who work with children who have CP will often describe the child as having low tone (hypotonia), high tone (hypertonia), or fluctuating tone. Other terms you may hear them use in discussing CP refer to the area of the body affected by the brain damage. Problems to one side of the body are referred to as hemiplegia. Quadriplegia occurs when the individual has upper and low body involvement. Diplegia describes lower body involvement and paraplegia describes upper body involvement. (Harris, 1987)

Vision Issues

"Over 40-75% of children with cerebral palsy have some form of a visual problem or impairment." (Black, P.D., 1980) They may have an acuity loss, field loss, oculomotor problem and/or a processing problem. These conditions often result in visual concentration issues and/or problems with eye-hand coordination. It is very important that an eye care specialist be consulted regularly for possible treatment, including glasses, eye patching, surgery, etc.

Acuity loss

An acuity loss typically makes things appear blurry. Nearsightedness (myopia) and farsightedness (hyperopia) are types of acuity loss caused when the image does not hit the retina correctly (refractive errors). Glasses are prescribed to help improve refractive errors. Those of us who have an acuity loss and wear glasses know how much information we miss from our environment when we don't have our glasses on. Glasses are very important for a child who has CP and acuity loss. Glasses can greatly improve incidental learning or learning that takes place by observation.

Field loss

The field of vision is everything you can see when you look straight ahead which is normally about 180 degrees in all directions. A field loss means that part(s) of the field is missing. Types of field losses include:

Oculomotor problems

An individual with CP may also experience conditions with their eye that can affect depth perception and smooth movements of the eye. These are called oculomotor problems and include:

Processing problems

This means that the child has problems making sense of visual information. Cortical visual impairment or CVI causes processing problems. CVI can cause the vision to fluctuate from day to day and minute to minute. It can also impact depth perception and cause a field loss.

Visual concentration and eye-hand coordination

Children with CP may also have problems with visual concentration and/or eye-hand skills. Many of the children expend so much energy and concentration on keeping their body upright, controlling an accurate reach, etc. they have little left over to use for visual tasks. Asking some children with CP to hold their body in alignment, look at a toy and then reach for it, might be like asking you to read War and Peace and put a bicycle together while serving your mother-in-law high tea. We are asking the child to do too much at one time. If we can support and stabilize his body, he will be able to concentrate on looking and reaching. If trunk and head control is the skill you want to work on, you may not want to use a visual toy as a motivator. As a team you need to consider the types of demands you are placing on the child within any given activity.

Hearing Loss and Language Problems

"Robinson (1983) noted that 20% of children with cerebral palsy display hearing or language problems." (Anthony, T. 1993) Typically the hearing loss is sensorineural. Beyond that, not much research has been done to date on hearing loss and CP. It is important, however, that children with CP also have their hearing assessed, especially if they also have a visual impairment.

Children with CP often have speech problems. This happens because the muscles that are used in producing speech (in the tongue, throat, lungs, etc.) are impacted by the CP, a condition known as dysarthria. Their speech may be slow and slurred. Their voices may have a very nasal quality (hypernasal) if too much air comes through the nose or sound like they have a bad cold if too little air comes through the nose (hyponasal). The child's facial features may also seem distorted when they are speaking. A speech therapist should be consulted to determine if a therapeutic approach might help the child with these problems.

Many people consider using voice output devices with individuals who have CP. Before making such a recommendation, it is important to thoroughly evaluate the child's hearing. His ability to use such a device will be impacted by how well he hears. He may also have problems hearing what the teacher says, participating in group discussions, or any other tasks that requires the use of hearing. If hearing and vision losses are both present, an educational approach for deafblindness should be used.

Learning Problems

Other problems that may impact learning for some children with CP include learning disabilities, mental retardation, and seizures. Good assessment should insure that these issues are appropriately addressed in developing the IEP and providing the necessary adaptations, modifications and related services the child needs to be successful.

Benefits of a Team Approach

It is critical that everyone who works with the child share information and ask questions. The parent, teachers of the visually impaired and hearing impaired, occupational and physical therapists, assistive technology specialist, orientation and mobility specialist, ophthalmologist and audiologist, classroom teacher and others have vital information that is necessary to consider when building a successful program for the child. When the team is designing activities for the child to participate in at home or at school, here are some of questions you might want to ask each other:

Resources on Cerebral Palsy

Organizations

Look in your phone book for your local Cerebral Palsy Center or contact :

United Cerebral Palsy Associations
1660 L. St. NW, Suite 700
Washington, DC 20036-5602
(800) 872-5827 (voice) or (202) 776-0406 (voice)
(202) 776-0414 (fax)
(202) 973-7197 (TTY)
<www.ucpa.org>

American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)
6300 North River Road, Suite 727
Rosemont, IL 60018-4226
(847) 698-1635 (voice)
(847) 823-0536 (fax)
Email: woppenhe@ucla.edu
Website: <http://aacpdm.org/>

This organization is a multidisciplinary scientific society devoted to the study of cerebral palsy and other childhood onset disabilities, promoting professional education for the treatment and management of these conditions, and improving the quality of life for people with these disabilities.

Internet Resources

<http://hometown.aol.com/anee/index.html> This is a site whose webmaster has cerebral palsy. This site provides good basic information as well as links to other sites dealing with cerebral palsy. Keep scrolling down and you will find information about cerebral palsy and visual impairments.

CP Tutorial - The Children's Medical Center of the University of Virginia offers this wonderful tutorial for parents, kids, and others related to CP. Check it out at: <http://hsc.virginia.edu/cmc/tutorials/cp/cp.htm>.

Books, Papers, and Videos

Bobath, B., and Bobath, K. Motor Development in the Different Types of Cerebral Palsy, 1975, Publisher: Heineman, London.

Finnie, Nancy. Handling Your Young Cerebral Palsied Child at Home, ISBN 0-452-26658-0, Publisher: Penguin USA, Phone: (800) 253-6476, PB $14.95.

Geralis, Elaine (Ed). Children With Cerebral Palsy: A Parents' Guide, 1991, ISBN 0-933149-15-8, Publisher: Woodbine House, Phone: (800) 843-7323, PB $14.95.

Miller, Freeman and Steven Bachrach, et al. Cerebral Palsy: A Complete Guide for Caregiving, 1995, ISBN 0-8018-5091-6, Publisher: Johns Hopkins University Press. Phone: (800) 537-5487, HC $35.95.

Schleichkorn, Jay. Coping with Cerebral Palsy: Answers to Questions Parents Often Ask 2nd ed.,1993, ISBN 0-890-795-762, Publisher: Pro-Ed, Phone: (512) 451-3246, PB $26.00.

The Management of the Child with CP with Low Vision; an NDT Perspective ($12), a monograph from North Rocks Press, Royal New South Wales Institute for Deaf and Blind Children, 361-365 North Rocks Road, North Rocks, NSW, 2151 Australia.

Handling and Positioning Young Children with Motor Impairments (30 minute video for $198 each) from Learner Managed Designs, P.O. Box 747, Lawrence, KS 66044, (800) 467-1644.

Feeding Young Infants and Children with Special Needs (30 minute video for $198 each) from Learner Managed Designs, P.O. Box 747, Lawrence, KS 66044, (800) 467-1644.

References:

Anthony, Tanni. Program development for young children with visual and physical disabilities. Proceedings of the Eighth International Conference on Blind and Visually Impaired Children. L. Stainton & E. Lechelt (Eds.). Canada, October 1993.

Black, P.D. Ocular defects in children with cerebral palsy. British Medical Journal, No. 281, 1980 pps. 487-488.

Harris, S . Early intervention for children with motor handicaps. The Effectiveness of Early Intervention for At-Risk and Handicapped Children, Academic Press, Inc. (1987).

Robinson, R. O. The frequency of other handicaps in children with cerebral palsy. Developmental Medicine and Child Neurology. No. 15, 1983. pps. 305-312.

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