National Dissemination Center for Children with Disabilities (NICHCY)
Jen was born 11 weeks early and weighed only 2½ pounds. The
doctors were surprised to see what a strong, wiggly girl she was.
But when Jen was just a few days old, she stopped breathing and
was put on a ventilator. After 24 hours she was able to breathe
on her own again. The doctors did a lot of tests to find out what
had happened, but they couldn't find anything wrong. The rest of
Jen's time in the hospital was quiet, and after two months she was
able to go home. Everyone thought she would be just fine.
home, Jen's mom noticed that Jen was really sloppy when she drank
from her bottle. As the months went by, Jen's mom noticed other
things she didn't remember seeing with Jen's older brother. At six
months, Jen didn't hold her head up straight. She cried a lot and
would go stiff with rage. When Jen went back for her six-month checkup,
the doctor was concerned by what he saw and what Jen's mom told
him. He suggested that Jen's mom take the little girl to a doctor
who could look closely at Jen's development. Jen's mom took her
to a developmental specialist who finally put a name to all the
little things that hadn't seemed right with Jen--cerebral palsy.
Cerebral palsy--also known as CP--is a condition caused by injury
to the parts of the brain that control our ability to use our muscles
and bodies. Cerebral means having to do with the brain. Palsy means
weakness or problems with using the muscles. Often the injury happens
before birth, sometimes during delivery, or, like Jen, soon after
being born. CP can be mild, moderate, or severe. Mild CP may mean
a child is clumsy. Moderate CP may mean the child walks with a limp.
He or she may need a special leg brace or a cane. More severe CP
can affect all parts of a child's physical abilities. A child with
moderate or severe CP may have to use a wheelchair and other special
equipment. Sometimes children with CP can also have learning problems,
problems with hearing or seeing (called sensory problems), or mental
retardation. Usually, the greater the injury to the brain, the more
severe the CP. However, CP doesn't get worse over time, and most
children with CP have a normal life span.
Palsy as an "Orthopedic Impairment"
The Individuals with Disabilities Education Act (IDEA) guides how
early intervention services and special education and related services
are provided to children with disabilities. Under IDEA, cerebral
palsy is considered an "orthopedic impairment," which
is defined as . . .
. . a severe orthopedic impairment that adversely affects a child's
educational performance. The term includes impairments caused by
congenital anomaly (e.g. clubfoot, absence of some member, etc.),
impairments caused by disease (e.g., poliomyelitis, bone tuberculosis,
etc.), and impairments from other causes (e.g., cerebral palsy,
amputations, and fractures or burns that cause contractures)."
34 Code of Federal Regulations Section 300.7(c)(8)
How Common is CP?
About 500,000 people in America have some form of CP. Each year
8,000 infants and nearly 1,500 preschool-age children are diagnosed
Are the Signs of CP?
There are three main types of CP:
CP is where there is too much muscle tone or tightness. Movements
are stiff, especially in the legs, arms, and/or back. Children with
this form of CP move their legs awkwardly, turning in or scissoring
their legs as they try to walk. This is the most common form of
CP (also called dyskinetic CP) can affect movements of the entire
body. Typically, this form of CP involves slow, uncontrolled body
movements and low muscle tone that makes it hard for the person
to sit straight and walk.
CP is a combination of the symptoms listed above. A child with mixed
CP has both high and low tone muscle. Some muscles are too tight,
and others are too loose, creating a mix of stiffness and involuntary
More words used to describe the different types of CP include:
means only the legs are affected.
means one half of the body (such as the right arm and leg) is affected.
means both arms and legs are affected, sometimes including the facial
muscles and torso.
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With early and ongoing treatment the effects of CP can be reduced.
Many children learn how to get their bodies to work for them in
other ways. For example, one infant whose CP keeps him from crawling
may be able to get around by rolling from place to place.
younger than three years old can benefit greatly from early intervention
services. Early intervention is a system of services to support
infants and toddlers with disabilities and their families. For older
children, special education and related services are available through
the public school to help each child achieve and learn.
children with CP may need different kinds of therapy, including:
therapy (PT), which helps the child develop stronger muscles such
as those in the legs and trunk. Through PT, the child works on skills
such as walking, sitting, and keeping his or her balance.
therapy (OT), which helps the child develop fine motor skills such
as dressing, feeding, writing, and other daily living tasks.
pathology (S/L), which helps the child develop his or her communication
skills. The child may work in particular on speaking, which may
be difficult due to problems with muscle tone of the tongue and
The child may also find a variety of special equipment helpful.
For example, braces (also called AFOs) may be used to hold the foot
in place when the child stands or walks. Custom splints can provide
support to help a child use his or her hands. A variety of therapy
equipment and adapted toys are available to help children play and
have fun while they are working their bodies. Activities such as
swimming or horseback riding can help strengthen weaker muscles
and relax the tighter ones.
medical treatments are being developed all the time. Sometimes surgery,
Botox injections, or other medications can help lessen the effects
of CP, but there is no cure for the condition.
A child with CP can face many challenges in school and is likely
to need individualized help. Fortunately, states are responsible
for meeting the educational needs of children with disabilities.
children up to age three, services are provided through an early
intervention system. Staff work with the child's family to develop
what is known as an Individualized Family Services Plan, or IFSP.
The IFSP will describe the child's unique needs as well as the services
the child will receive to address those needs. The IFSP will also
emphasize the unique needs of the family, so that parents and other
family members will know how to help their young child with CP.
Early intervention services may be provided on a sliding-fee basis,
meaning that the costs to the family will depend upon their income.
school-aged children, including preschoolers, special education
and related services will be provided through the school system.
School staff will work with the child's parents to develop an Individualized
Education Program, or IEP. The IEP is similar to an IFSP in that
it describes the child's unique needs and the services that have
been designed to meet those needs. Special education and related
services, which can include PT, OT, and speech-language pathology,
are provided at no cost to parents.
addition to therapy services and special equipment, children with
CP may need what is known as assistive technology. Examples of assistive
devices, which can range from the simple to the sophisticated. Communication
boards, for example, have pictures, symbols, letters, or words attached.
The child communicates by pointing to or gazing at the pictures
or symbols. Augmentative communication devices are more sophisticated
and include voice synthesizers that enable the child to "talk"
technology, which can range from electronic toys with special switches
to sophisticated computer programs operated by simple switch pads
or keyboard adaptations.
ability of the brain to find new ways of working after an injury
is remarkable. Even so, it can be difficult for parents to imagine
what their child's future will be like. Good therapy and handling
can help, but the most important "treatment" the child
can receive is love and encouragement, with lots of typical childhood
experiences, family, and friends. With the right mix of support,
equipment, extra time, and accommodations, all children with CP
can be successful learners and full participants in life.
Learn about CP. The more you know, the more you can help yourself
and your child. See the list of resources and organizations at the
end of this publication.
and play with your child. Treat your son or daughter as you would
a child without disabilities. Take your child places, read together,
from professionals and other parents how to meet your child's special
needs, but try not to turn your lives into one round of therapy
for help from family and friends. Caring for a child with CP is
hard work. Teach others what to do and give them plenty of opportunities
to practice while you take a break.
informed about new treatments and technologies that may help. New
approaches are constantly being worked on and can make a huge difference
to the quality of your child's life. However, be careful about unproven
about assistive technology that can help your child. This may include
a simple communication board to help your child express needs and
desires, or may be as sophisticated as a computer with special software.
patient, keep up your hope for improvement. Your child, like every
child, has a whole lifetime to learn and grow.
with professionals in early intervention or in your school to develop
an IFSP or an IEP that reflects your child's needs and abilities.
Be sure to include related services such as speech-language pathology,
physical therapy, and occupational therapy if your child needs these.
Don't forget about assistive technology either!
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Learn more about CP. The resources and organizations at the end
of this publication will help you.
may seem obvious, but sometimes the "look" of CP can given
the mistaken impression that a child who has CP cannot learn as
much as others. Focus on the individual child and learn firsthand
what needs and capabilities he or she has.
into the strategies that teachers of students with learning disabilities
use for their students. Become knowledgeable about different learning
styles. Then you can use the approach best suited for a particular
child, based upon that child's learning abilities as well as physical
inventive. Ask yourself (and others), "How can I adapt this
lesson for this child to maximize active, hands-on learning?"
to love assistive technology. Find experts within and outside your
school to help you. Assistive technology can mean the difference
between independence for your student or not.
remember, parents are experts, too. Talk candidly with your student's
parents. They can tell you a great deal about their daughter or
son's special needs and abilities.
teamwork for the child with CP needs to bring together professionals
with diverse backgrounds and expertise. The team must combine the
knowledge of its members to plan, implement, and coordinate the
Geralis, E. (1998). Children with cerebral palsy: A parents' guide
(2nd ed.). Bethesda, MD: Woodbine House. (Telephone: 800.843.7323.
K.A., & Holt, R. (2000). Family guide to assistive technology.
Cambridge, MA: Brookline Books. (Telephone: 800.666.2665. Web: www.brooklinebooks.com)
F., & Bachrach, S.J. (1998). Cerebral palsy: A complete guide
for caregiving. Baltimore, MD: Johns Hopkins University Press. (Telephone:
800.537.5487. Web: www.press.jhu.edu)
to rent: My Left Foot and Gaby: A True Story.
United Cerebral Palsy Associations, Inc.
1660 L Street NW, Suite 700
Washington DC 20036
230 West Monroe Street, Suite 1800
Chicago, IL 60606-4802
Site of the National Institute of Neurological Disorders and Stroke
at the National Institutes of Health
A nonprofit information clearinghouse on assistive technology
Ideas and instructions for adapting toys for use by children with
NICHCY State Resources Sheets list organizations in the state addressing
cerebral palsy, assistive technology, and other disability-related
issues and concerns. For more information:
P.O. Box 1492
Washington, DC 20013
(800) 695-0285 · v/tty
(202) 884-8441 · fax
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between the Academy for Educational Development and the Office of
Special Education Programs of the U.S. Department of Education.
The contents of this document do not necessarily reflect the views
or policies of the Department of Education, nor does mention of
trade names, commercial products, or organizations imply endorsement
by the U.S. Government.
information presented on this site is intended solely as a general
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advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.