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Diagnosis and Intervention for Children with Cerebral Palsy
 An interview with John P. Dormans, M.D., co-author of Caring for Children with Cerebral Palsy: A Team Approach. From the November 2001 Disabilities newsletter.Q: What causes cerebral palsy? A: Historically, cerebral palsy has been attributed to anomalies of the birthing process, specifically birth asphyxia. However, studies over the last 15 years have attributed cerebral palsy to prenatal factors that result in lesions or anomalies affecting the child's brain. Such factors may be maternal, constitutional, genetic, or pregnancy specific. They can also be caused by prenatal illness and infection or by the mother's use of alcohol or illicit drugs. Neonatal and post-newborn infants may develop cerebral palsy due to traumatic brain injury through an accident or due to an infection such as meningitis. Premature infants have a high vulnerability to such factors and are therefore at risk for anomalies or lesions of the developing brain that may result in cerebral palsy. Q: When and how is a diagnosis of cerebral palsy usually made? A: If a child has significantly delayed motor and mobility functions at 2 years of age, cerebral palsy may be diagnosed. This diagnosis will be made based on the discovery of a break in the profile of skills across defined functional and developmental domains. For a child to be diagnosed with cerebral palsy, the following must be identified: movement and posture disorder through the analysis of abnormal motor development, abnormality in the development of the brain based on medical evaluation and etiological testing, and the absence of a non-progressive neurodegenerative condition. Cerebral palsy can be further sub-categorized based on the area of motor decrement and the type of abnormal movements displayed. The evaluation of a child's basic sensory and motor processes occurs at a clinical visit while the evaluation of integrated processes, including everyday skills, occurs through family and teacher interviews. It is important to differentiate between cerebral palsy and other neurological disorders that mimic many of the traits characteristic of cerebral palsy. Magnetic resonance imaging and analysis of the child's personal and genetic history can help avoid misdiagnosis. Q: What medical and educational supports do children with cerebral palsy require? A: Federal legislation ensures that all children with cerebral palsy (CP) receive free appropriate public education (FAPE) in the least restrictive environment (LRE) possible. Schools are required to provide technology-based assistance and transition planning for children with CP such that they may receive an education in a LRE. Recently, schools have been required to provide children with CP the same educational opportunities experienced by typically developing students that can then be supplemented by additional resource classes. To qualify for FAPE, children with cerebral palsy undergo school-based evaluation before they are assigned an individualized education program (IEP). Children with CP require the same preventative and anticipatory care that typically developing children receive. It is important for physicians and parents to recognize the psychosocial affects that CP may cause as a result of physical difficulties characteristic of CP. Children with CP may have additional developmental and system disorders that may require special gastrointestinal, orthopedic, and/or dental care. It is important that primary care providers recognize the higher prevalence of such disorders in children with CP. Q: How can care for children with cerebral palsy be coordinated across professional disciplines? A: Interdisciplinary intervention is executed with the child's best interests in mind. This psychoeducational intervention model utilizes a team that works together in order to provide the most beneficial care for the child. This team includes a primary care physician, necessary specialists/therapists, and the child's family. The goal for this team must be to improve quality of life for the child through habilitation into society. Families and professionals must communicate well so that the expertise of each is optimally utilized when considering the wide variety of environments and physical and emotional changes that the child will experience over his or her lifetime.
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