Picture Source : https://pediatricorthopedics.com/understanding-cerebral-palsy
Definition of Cerebral Palsy
Cerebral Palsy is defined as:
“A group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”(Rosenbaum et al., 2007:9)
Rosenbaum et al. (2007)
Bax et al. (2005)
World Health Organization (WHO)
National Institute of Neurological Disorders and Stroke (NINDS)
Krigger (2006)
Nelson and Ellenberg (1986)
Shevell et al. (2003)
Odding, Roebroeck, and Stam (2006)
Parkes, Hill, and Platt (2001)
Himmelmann and Uvebrant (2011)
These definitions emphasize the non-progressive, early-onset, and neurological nature of cerebral palsy, with variability in severity and associated impairments. Contemporary definitions, such as that by Rosenbaum et al., also incorporate activity limitations and functional aspects, aligning with the International Classification of Functioning, Disability and Health (ICF) framework by the WHO.
If you need a comparative table, annotated bibliography, or synthesized summary for these definitions, I’d be happy to assist further.
Causes of Cerebral Palsy
The causes of CP are multifactorial and can be classified into prenatal, perinatal, and postnatal factors:
1. Prenatal Causes (before birth)
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Congenital brain malformations
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Intrauterine infections (e.g., toxoplasmosis, rubella, cytomegalovirus)
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Placental insufficiency
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Genetic mutations
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Exposure to toxins or radiation
2. Perinatal Causes (during birth)
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Asphyxia neonatorum (oxygen deprivation during labor)
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Premature birth and low birth weight
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Birth trauma or prolonged labor
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Neonatal stroke
3. Postnatal Causes (after birth)
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Head injuries
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Meningitis or encephalitis
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Severe jaundice (kernicterus)
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Seizures
(Oskoui et al., 2013; Novak et al., 2017)
Prenatal Causes (Before Birth)
Prenatal factors are the most common causes of CP, accounting for approximately 70–80% of all cases (Nelson & Blair, 2015). These include:
a. Genetic Mutations
Recent studies indicate that up to 14% of CP cases are linked to de novo genetic mutations (McMichael et al., 2015). Mutations in genes such as GAD1, TUBA1A, and COL4A1 affect brain development and increase vulnerability to perinatal injury.
b. Intrauterine Infections
Maternal infections such as cytomegalovirus (CMV), toxoplasmosis, rubella, and herpes simplex virus can lead to fetal brain inflammation and injury (Adams-Chapman & Stoll, 2006).
c. Placental Insufficiency
Impaired placental function may cause fetal hypoxia-ischemia, a major risk factor for white matter injury in preterm infants (Volpe, 2009). This is especially linked to periventricular leukomalacia (PVL), a hallmark of CP in preterm births.
d. Maternal Conditions
Hypertension, diabetes, thyroid dysfunction, and coagulopathies increase the risk of fetal brain injury (Shevell & Majnemer, 2001).
Perinatal Causes (Around the Time of Birth)
Perinatal risk factors are primarily associated with complications during labor and delivery, accounting for approximately 10–15% of CP cases.
a. Birth Asphyxia / Hypoxic-Ischemic Encephalopathy (HIE)
A lack of oxygen during labor or delivery can lead to significant brain injury. HIE is a well-established cause of spastic quadriplegic CP in term infants (Badawi et al., 1998).
b. Premature Birth and Low Birth Weight
Prematurity (<37 weeks gestation) and very low birth weight (<1500g) are among the strongest predictors of CP due to the increased vulnerability of the immature brain to injury (Walstab et al., 2004).
c. Multiple Pregnancies
Twins or higher-order multiples are at increased risk due to shared placental circulation and higher rates of prematurity (Thorngren-Jerneck & Herbst, 2006).
d. Obstetric Complications
Complications such as uterine rupture, placental abruption, or prolonged labor may lead to reduced oxygen supply, increasing the risk of CP (Raghuveer et al., 2002).
Postnatal Causes (After Birth)
Though less common, postnatal causes account for approximately 5–10% of CP cases, particularly in the first two years of life.
a. Neonatal Infections
Infections like meningitis, encephalitis, and sepsis can lead to inflammation and secondary damage to brain tissue (Blair & Stanley, 1982).
b. Traumatic Brain Injury (TBI)
Falls, abusive head trauma (shaken baby syndrome), and vehicular accidents during infancy can result in acquired CP (Himmelmann et al., 2006).
c. Stroke or Hemorrhage
Neonatal stroke, often due to clotting disorders or congenital heart disease, may cause focal lesions in motor areas (Kirton et al., 2008).
d. Severe Untreated Jaundice (Kernicterus)
Excess bilirubin can cross the blood-brain barrier and damage the basal ganglia, particularly in cases of Rh incompatibility (Watchko & Tiribelli, 2013).
Multifactorial and Unknown Causes
In many cases, the cause remains unknown or multifactorial, involving an interplay of genetic predisposition and environmental insults (Nelson, 2003). Even in the absence of a clear perinatal event, minor anomalies during brain development may contribute.
Cerebral palsy is a complex condition with diverse etiologies. Understanding the specific causes—prenatal, perinatal, and postnatal—is essential for effective prevention, early diagnosis, and intervention. The growing field of neurogenetics, alongside improvements in perinatal care and neuroimaging, continues to enhance our understanding of CP's origins.
Types of Cerebral Palsy
Cerebral Palsy can be categorized by the type of movement disorder involved:
| Type | Characteristics |
|---|---|
| Spastic CP | Muscle stiffness and tightness; most common type (around 70-80%) |
| Dyskinetic CP | Involuntary, uncontrolled movements |
| Ataxic CP | Poor coordination and balance |
| Mixed CP | Combination of symptoms from above types |
Teaching Techniques for Children with Cerebral Palsy
Inclusive and adaptive teaching practices are essential for learners with CP. These children may face difficulties in mobility, speech, coordination, perception, and cognition, depending on the severity and type of CP.
1. Individualized Education Plan (IEP)
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Based on assessment of physical, cognitive, and emotional needs
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Collaboration among teachers, therapists, parents, and the child
2. Assistive Technology
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Use of speech-generating devices, modified keyboards, touch screens, and wheelchair-accessible materials
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Communication boards or AAC (Augmentative and Alternative Communication) tools
3. Multisensory Teaching Approach
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Combine visual, auditory, tactile, and kinesthetic learning methods
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Hands-on learning improves motor planning and engagement(Carpenter et al., 2015)
4. Task Simplification and Step-by-Step Instruction
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Break down tasks into small, manageable parts
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Use repetition and visual schedules
5. Physical Accommodations
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Adapt classroom layout to allow movement
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Provide appropriate seating or supportive equipment
6. Collaboration with Therapists
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Occupational therapists help with fine motor skills
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Speech therapists address communication and feeding issues
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Physiotherapists improve posture and mobility
7. Encouraging Peer Interaction
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Promote cooperative learning and social inclusion
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Use peer buddies or support groups to foster self-esteem
(Source: Palisano et al., 2012; Dettmer et al., 2005; Westling & Fox, 2004)
Challenges in Teaching Students with CP
Physical and Motor Impairments
Motor dysfunctions are the hallmark of CP and include spasticity, dyskinesia, and ataxia (Bax et al., 2005). These affect students' posture, mobility, and fine motor control.
Implications for Teaching:
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Difficulty writing or using classroom tools (Harris & Riddell, 2009)
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Challenges in physical participation during classroom activities
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Fatigue and discomfort during extended sitting or movement
Strategies Suggested: Use of assistive technology (e.g., speech-to-text software, modified keyboards), adapted seating, and physical therapy integration into the school day (Simeonsson et al., 2001).
Communication Barriers
Many students with CP have speech and language disorders due to impaired muscle control affecting articulation and respiratory function (Pennington et al., 2010).
Implications for Teaching:
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Reduced classroom interaction and social participation
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Challenges in demonstrating knowledge through oral responses
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Misinterpretation of intellectual ability due to non-verbal status
Strategies Suggested: Implementation of augmentative and alternative communication (AAC) systems such as picture boards and voice output communication aids (Light & Drager, 2007).
Cognitive and Learning Difficulties
Although intellectual ability varies, approximately 30–50% of students with CP experience cognitive impairments (Odding et al., 2006). These may include:
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Attention deficits
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Executive function disorders
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Visual-spatial difficulties
Implications for Teaching:
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Difficulty understanding abstract concepts or multi-step instructions
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Slower information processing and task completion
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Need for differentiated instruction
Strategies Suggested: Use of individualized education plans (IEPs), multimodal teaching strategies, and frequent breaks to manage cognitive load (Hodapp & Dykens, 2009).
Sensory Processing Issues
Sensory deficits, especially visual and auditory impairments, are common in children with CP (Ostensjø et al., 2005).
Implications for Teaching:
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Difficulty in accessing visual material (e.g., board work, diagrams)
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Discomfort or confusion in overstimulating environments
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Reduced capacity for independent learning
Strategies Suggested: Enlarged print materials, auditory books, controlled sensory environments, and orientation and mobility training.
Emotional and Behavioral Challenges
Students with CP may exhibit emotional distress, anxiety, or low self-esteem, partly due to frustration, social isolation, or over-dependence on adults (Shin et al., 2006).
Implications for Teaching:
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Withdrawal or disruptive behaviors in the classroom
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Reluctance to engage or take academic risks
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Difficulty forming peer relationships
Strategies Suggested: Positive behavior interventions and supports (PBIS), inclusive classroom activities, and social skills training (Macartney, 2008).
Teacher Preparedness and Professional Development
A significant barrier to effective teaching is the lack of specialized training among educators in inclusive pedagogy and disability-specific strategies (Florian & Black-Hawkins, 2011).
Implications:
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Teachers may feel unprepared or overwhelmed
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Overreliance on aides or special educators
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Lower expectations for academic performance
Recommendations: Pre-service and in-service teacher education programs should include content on CP and inclusive education practices (Forlin & Chambers, 2011).
Environmental and Institutional Barriers
Physical infrastructure, classroom design, and institutional policy can hinder the inclusion of students with CP.
Implications:
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Inaccessible classrooms, restrooms, or transport
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Lack of assistive technology or support staff
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Policy gaps in individualized educational support
Policy Recommendations: Enforceable inclusive education policies, funding for accessibility, and integration of medical and educational services (UNESCO, 2020).
Collaboration with Families and Specialists
Interdisciplinary collaboration is vital but often inconsistent due to time, training, or institutional constraints.
Challenges:
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Communication gaps between families and schools
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Limited coordination among teachers, therapists, and medical professionals
Conclusion
Cerebral Palsy is a complex neurodevelopmental disorder that requires comprehensive, interdisciplinary support in educational settings. Through inclusive teaching techniques, technological support, and tailored interventions, educators can facilitate meaningful learning experiences for children with CP, enabling them to thrive academically and socially.
References
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Rosenbaum, P., Paneth, N., Leviton, A., et al. (2007). A report: The definition and classification of cerebral palsy April 2006. Developmental Medicine & Child Neurology Supplement, 109, 8-14.
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Novak, I., Morgan, C., Adde, L., et al. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatrics, 171(9), 897-907.
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Oskoui, M., Coutinho, F., Dykeman, J., Jette, N., & Pringsheim, T. (2013). An update on the prevalence of cerebral palsy: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology, 55(6), 509-519.
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Bax, M., Goldstein, M., Rosenbaum, P., et al. (2005). Proposed definition and classification of cerebral palsy. Developmental Medicine & Child Neurology, 47(8), 571–576.
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Palisano, R., Rosenbaum, P., Bartlett, D., & Livingston, M. (2012). Content validity of the expanded and revised Gross Motor Function Classification System. Developmental Medicine & Child Neurology, 50(10), 744-750.
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Carpenter, B., Egerton, J., Cockbill, B., Bloom, T., & Fotheringham, J. (2015). Engaging Learners with Complex Learning Difficulties and Disabilities. Routledge.
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Westling, D. L., & Fox, L. (2004). Teaching Students with Severe Disabilities. Merrill/Prentice Hall.
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Dettmer, P., Thurston, L. P., & Dyck, N. (2005). Consultation, Collaboration, and Teamwork for Students with Special Needs. Pearson Education.
Adams-Chapman, I., & Stoll, B. J. (2006). Neonatal infection and long-term neurodevelopmental outcome in the preterm infant. Current Opinion in Infectious Diseases, 19(3), 290–297.
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Badawi, N., et al. (1998). Intrapartum risk factors for newborn encephalopathy: The Western Australian case-control study. BMJ, 317(7172), 1554–1558.
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Blair, E., & Stanley, F. (1982). Aetiological pathways to cerebral palsy. Paediatric and Perinatal Epidemiology, 2(3), 305–319.
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Himmelmann, K., et al. (2006). Aetiology and timing of spastic cerebral palsy. Acta Paediatrica, 95(8), 961–968.
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Kirton, A., et al. (2008). Stroke in children: Management and outcomes. Canadian Medical Association Journal, 178(5), 573–580.
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McMichael, G., et al. (2015). Whole-exome sequencing points to considerable genetic heterogeneity of cerebral palsy. Molecular Psychiatry, 20, 176–182.
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Nelson, K. B. (2003). Can we prevent cerebral palsy?. New England Journal of Medicine, 349(18), 1765–1769.
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Nelson, K. B., & Blair, E. (2015). Prenatal factors in singletons with cerebral palsy born at or near term. New England Journal of Medicine, 373(10), 946–953.
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Shevell, M. I., & Majnemer, A. (2001). The causes of cerebral palsy: Current concepts. Canadian Medical Association Journal, 165(4), 445–452.
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Volpe, J. J. (2009). Brain injury in premature infants: A complex amalgam of destructive and developmental disturbances. The Lancet Neurology, 8(1), 110–124.
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Watchko, J. F., & Tiribelli, C. (2013). Bilirubin-induced neurologic damage—mechanisms and management approaches. New England Journal of Medicine, 369(21), 2021–2030.
- Bax, M., Goldstein, M., Rosenbaum, P., et al. (2005). Proposed definition and classification of cerebral palsy. Developmental Medicine & Child Neurology, 47(8), 571–576.
- Florian, L., & Black-Hawkins, K. (2011). Exploring inclusive pedagogy. British Educational Research Journal, 37(5), 813–828.
- Forlin, C., & Chambers, D. (2011). Teacher preparation for inclusive education. International Journal of Inclusive Education, 15(3), 385–400.
- Harris, R., & Riddell, S. (2009). Disability, equality, and human rights. Scandinavian Journal of Disability Research, 11(2), 139–153.
- Hodapp, R. M., & Dykens, E. M. (2009). Intellectual disabilities and child psychopathology. Journal of Child Psychology and Psychiatry, 50(6), 552–561.
- King, G., Law, M., King, S., et al. (2009). Family-centred service for children with cerebral palsy. Child: Care, Health and Development, 30(3), 265–277.
- Light, J., & Drager, K. (2007). AAC technologies for young children with complex communication needs. Pediatrics, 119(6), e1285–e1292.
- Macartney, B. (2008). “Playing the game”: Tensions and dilemmas for inclusive educators. New Zealand Journal of Educational Studies, 43(1), 25–37.
- Odding, E., Roebroeck, M. E., & Stam, H. J. (2006). The epidemiology of cerebral palsy. Disability and Rehabilitation, 28(4), 183–191.
- Ostensjø, S., Carlberg, E. B., & Vøllestad, N. K. (2005). Motor skills, daily activities, and quality of life in children with CP. Developmental Medicine & Child Neurology, 47(9), 660–667.
- Pennington, L., Goldbart, J., & Marshall, J. (2010). Speech, language and communication needs of children with cerebral palsy. International Journal of Language & Communication Disorders, 41(6), 713–734.
- Shin, M., Besser, L. M., Siffel, C., et al. (2006). Prevalence of cerebral palsy. Pediatrics, 117(2), 528–533.
- Simeonsson, R. J., Carlson, D., Huntington, G. S., et al. (2001). Students with disabilities: A national survey. Exceptional Children, 67(4), 411–424.
- UNESCO. (2020). Global Education Monitoring Report: Inclusion and education: All means all. Paris: UNESCO Publishing.
