Including Students with Cerebral Palsy in Including Students with Cerebral Palsy in the Primary Classroomthe Primary Classroom

Shannon Rust-Dickey Shannon Rust-Dickey

EDSP 6644EDSP 6644

Fall, 2005Fall, 2005

Effects of Cerebral PalsyEffects of Cerebral Palsy Main features of Cerebral Palsy (CP)Main features of Cerebral Palsy (CP)

CP is a condition caused by damage to the brain, CP is a condition caused by damage to the brain, usually occurring before, during, or shortly after birth.usually occurring before, during, or shortly after birth.

““Cerebral” refers to the brain and “Palsy” to a disorder Cerebral” refers to the brain and “Palsy” to a disorder of movement or posture. A lack of muscle control of movement or posture. A lack of muscle control (Council for Exceptional Children).(Council for Exceptional Children).

Non progressiveNon progressive There is not a cure for CP, but advances in medicine There is not a cure for CP, but advances in medicine

and rehabilitation technology offer hope for people who and rehabilitation technology offer hope for people who have CP.have CP.

Four main types of CPFour main types of CP Spastic: Stiff and difficult movement. 70-80% of people Spastic: Stiff and difficult movement. 70-80% of people

who have CP have this type (CDC) who have CP have this type (CDC) Athetoid or dyskinetic: Involuntary movement of musclesAthetoid or dyskinetic: Involuntary movement of muscles Ataxic:Disturbed sense of balance of depth perceptionAtaxic:Disturbed sense of balance of depth perception Mixed: Combination of more than one type Mixed: Combination of more than one type

Effects of CP, (cont.)Effects of CP, (cont.)

Contradicting DefinitionsContradicting Definitions Hallahan & Kauffman (2006) were one of the few sources I Hallahan & Kauffman (2006) were one of the few sources I

found who consider CP to be more than motor impairment. found who consider CP to be more than motor impairment. They say CP can be considered part of a syndrome that They say CP can be considered part of a syndrome that includes motor dysfunction, psychological dysfunction, includes motor dysfunction, psychological dysfunction, seizures, and emotional or behavioral disorders due to brain seizures, and emotional or behavioral disorders due to brain damage. damage.

Other sources would say that people with CP are often Other sources would say that people with CP are often affected by other disorders which account for other affected by other disorders which account for other challenges than motor impairment (National Institute of challenges than motor impairment (National Institute of Neurological Disorders and Stroke).Neurological Disorders and Stroke).

For the purposes of this presentation, I am going with the For the purposes of this presentation, I am going with the majority and focusing on CP as being primarily a lack of majority and focusing on CP as being primarily a lack of motor impairment and muscle control.motor impairment and muscle control.

These features differ from other disabilitiesThese features differ from other disabilities People with CP have great challenges with motor impairment. People with CP have great challenges with motor impairment.

They may have average intelligence but have troubles seeing They may have average intelligence but have troubles seeing or hearing (Courbois, Coello, & Bouchart). or hearing (Courbois, Coello, & Bouchart).

This is different from other disabilities since most other This is different from other disabilities since most other disabilities have more difficulties with psychological disabilities have more difficulties with psychological dysfunctions.dysfunctions.

Modifying the Learning EnvironmentModifying the Learning Environment

AccommodationsAccommodations Allowing students to take tests orally or allow students to take Allowing students to take tests orally or allow students to take

tests in writing and then have them orally explain their answers.tests in writing and then have them orally explain their answers. Have a scribe for the studentHave a scribe for the student Math manipulativesMath manipulatives Allow extra time to complete assignmentsAllow extra time to complete assignments Adaptive typewriters, pencil holders, page turners, book holdersAdaptive typewriters, pencil holders, page turners, book holders Voice-output augmentative communication technology (if Voice-output augmentative communication technology (if

needed)needed) Cards to use in place of speechCards to use in place of speech Provide bigger spaces on worksheets to write answersProvide bigger spaces on worksheets to write answers

Modifications (In PE)Modifications (In PE) Having a student with CP walk with their walker (if Having a student with CP walk with their walker (if

appropriate for that child) from one side of the field to the appropriate for that child) from one side of the field to the other instead of having them run 2 laps with the rest of the other instead of having them run 2 laps with the rest of the class.class.

Modifying the Learning Environment, (cont.)Modifying the Learning Environment, (cont.)

The physical environment of the classroomThe physical environment of the classroom Must have room for a walker and or wheelchair to access Must have room for a walker and or wheelchair to access

places (centers would be an example in a primary classroom)places (centers would be an example in a primary classroom) Need space to store the walker and wheelchair when not in Need space to store the walker and wheelchair when not in

use.use. Place for a special desk and chair if student uses one.Place for a special desk and chair if student uses one.

Students with CP would most likely require more Students with CP would most likely require more accommodations than modifications when it comes to accommodations than modifications when it comes to school. Students with CP can usually achieve the school. Students with CP can usually achieve the same goals as others students in the general same goals as others students in the general curriculum. They may just need a small change in curriculum. They may just need a small change in order to do so.order to do so.

Developmental ConsiderationsDevelopmental Considerations

Language, Sight, and/or Hearing DisordersLanguage, Sight, and/or Hearing Disorders Some people with CP have difficulties speaking and some Some people with CP have difficulties speaking and some

cannot speak at all. Others may have difficulties seeing or cannot speak at all. Others may have difficulties seeing or hearing, too!hearing, too!

Social-emotional developmentSocial-emotional development Students with CP may have a difficult time fitting in with Students with CP may have a difficult time fitting in with

peers. They may feel depressed about certain physical peers. They may feel depressed about certain physical incapability's - especially if no other disabilities are present incapability's - especially if no other disabilities are present and their intelligence is normal to above normal (British and their intelligence is normal to above normal (British Columbia Dept. of Education). Columbia Dept. of Education).

Other motor impairmentsOther motor impairments Students may be wheelchair boundStudents may be wheelchair bound Students may use a walkerStudents may use a walker Students may crawl around the classroomStudents may crawl around the classroom

Developmental Considerations, (cont.)Developmental Considerations, (cont.)

How developmental factors influence teachingHow developmental factors influence teaching The arrangement of the classroom (wheelchair and/or walker The arrangement of the classroom (wheelchair and/or walker

accessible)accessible) Scheduling (be careful not to schedule tests when the student Scheduling (be careful not to schedule tests when the student

is at therapy) and you will also probably have to schedule is at therapy) and you will also probably have to schedule bathroom times as many students with CP need assistance in bathroom times as many students with CP need assistance in the restroom.the restroom.

For special activities outside of the classroom or school (field For special activities outside of the classroom or school (field trips), make sure appropriate arrangements have been made trips), make sure appropriate arrangements have been made so the student can participate (British Columbia Dept. of so the student can participate (British Columbia Dept. of Education).Education).

Work with other professionals as a team to help the student. Work with other professionals as a team to help the student. Many students with CP will see one or all of the following:Many students with CP will see one or all of the following:

Speech Therapist, Occupational Therapist, Physical Speech Therapist, Occupational Therapist, Physical Therapist, Special Education Teachers, Para Professional, Therapist, Special Education Teachers, Para Professional, Counselors.Counselors.

Monitor Student ProgressMonitor Student Progress CP can impact learning since students need the use of their CP can impact learning since students need the use of their

hands to learn to write, read, manipulate objects, draw, and hands to learn to write, read, manipulate objects, draw, and color.color. To help students with these challenges, we can provide To help students with these challenges, we can provide

appropriate accommodations and help them learn how to appropriate accommodations and help them learn how to function with their difficulties.function with their difficulties.

Provide magnetic letters during writing timeProvide magnetic letters during writing time Provide computer time (if available at your school) since Provide computer time (if available at your school) since

computers can facilitate literacy learning in students with computers can facilitate literacy learning in students with CP (Dennis, 1995)CP (Dennis, 1995)

Provide bigger manipulatives during mathProvide bigger manipulatives during math Students also need the use of their voices during school. If Students also need the use of their voices during school. If

they cannot speak, we have to find other ways for them to they cannot speak, we have to find other ways for them to communicate with us and show us what they know. We communicate with us and show us what they know. We might think they don’t know things, especially in the area might think they don’t know things, especially in the area of reading, when in actuality they just cannot let us know.of reading, when in actuality they just cannot let us know. To help students with this challenge, we can try to advocate to To help students with this challenge, we can try to advocate to

get them appropriate technology to assist them with speaking.get them appropriate technology to assist them with speaking. Voice-output augmentative communication technology has Voice-output augmentative communication technology has

been found to lead to improved communication skills as well been found to lead to improved communication skills as well as increased demonstratiosn of literacy capabilites as increased demonstratiosn of literacy capabilites (Erickson & Koppenhaver, 1997).(Erickson & Koppenhaver, 1997).

Monitor Student Progress, (cont.)Monitor Student Progress, (cont.) According to Hallahan and Kauffman (2006), the According to Hallahan and Kauffman (2006), the

educational problems of children who have CP educational problems of children who have CP can be multifaceted.can be multifaceted.

These students need accommodations and These students need accommodations and assistance with most activities in the general assistance with most activities in the general education classroom.education classroom.

Para educators are often necessary for students Para educators are often necessary for students with CP. Some students may require a full-time with CP. Some students may require a full-time Para educator while others may simply need Para educator while others may simply need assistance with a few things (British Columbia assistance with a few things (British Columbia Dept. of Education).Dept. of Education).

Students with CP, even if they have average Students with CP, even if they have average intelligence, often need more assistance than intelligence, often need more assistance than students with other disabilities due to the great students with other disabilities due to the great amount of motor impairment. amount of motor impairment.

Differentiating Instruction – Classroom Differentiating Instruction – Classroom StrategiesStrategies

Examples of differentiating instruction for students with Examples of differentiating instruction for students with

CPCP Providing a pattern when working on an art project instead of Providing a pattern when working on an art project instead of

having them get frustrated with free hand.having them get frustrated with free hand. In math, allow the student to show they can add and subtract In math, allow the student to show they can add and subtract

using manipulates instead of writing.using manipulates instead of writing. If note-taking is required, provide the notes for the student.If note-taking is required, provide the notes for the student. Work with small groupsWork with small groups Allow students to work in groupsAllow students to work in groups Accept work that may not be legible and then later have the Accept work that may not be legible and then later have the

student explain what they wrote (Awareness of Chronic student explain what they wrote (Awareness of Chronic Health Conditions)Health Conditions)

Since CP is primarily a disability of motor dysfunction, Since CP is primarily a disability of motor dysfunction, differentiating instruction for academics should not be differentiating instruction for academics should not be necessary unless the student also has another disability.necessary unless the student also has another disability.

Choosing and Implementing Strategies Choosing and Implementing Strategies

and Interventionsand Interventions There are several strategies to assist students with CP. There are several strategies to assist students with CP.

General educators can use all of them in the classroom.General educators can use all of them in the classroom.

For students with reading, writing, and/or math difficultiesFor students with reading, writing, and/or math difficulties Similar to what you would do with general education peersSimilar to what you would do with general education peers

Text-rich environment, read aloud to students, provide Text-rich environment, read aloud to students, provide individual or small group instruction with just what the individual or small group instruction with just what the child needs (Dennis, 1995).child needs (Dennis, 1995).

Provide extra assistance, tutoring, monitor progress very Provide extra assistance, tutoring, monitor progress very closely, differentiate instruction, assessment needs to drive closely, differentiate instruction, assessment needs to drive instructioninstruction

For these interventions to work, we must ensure students For these interventions to work, we must ensure students are receiving appropriate accommodations for their motor are receiving appropriate accommodations for their motor impairments. impairments.

Using the IEP to Plan InstructionUsing the IEP to Plan Instruction Goals for students who have CPGoals for students who have CP

Toileting aloneToileting alone Dress themselvesDress themselves Write legiblyWrite legibly Use scissors and pencils Use scissors and pencils Learn to use assistive technology Learn to use assistive technology Learn to manipulate and use a walker appropriatelyLearn to manipulate and use a walker appropriately Transfer in and out of wheelchair aloneTransfer in and out of wheelchair alone Learn to read and do math at the same rate as general Learn to read and do math at the same rate as general

education peers (if no other disability is present)education peers (if no other disability is present) Role of the general educator in reaching these goalsRole of the general educator in reaching these goals

Be a part of the IEP team and be familiar with goals and objectivesBe a part of the IEP team and be familiar with goals and objectives Consistently provide needed accommodations as stated in the IEPConsistently provide needed accommodations as stated in the IEP General educators should focus on the academic goals on the IEP. General educators should focus on the academic goals on the IEP.

They should help students with CP learn to read, write, and do They should help students with CP learn to read, write, and do math at an appropriate level for their abilities – just like general math at an appropriate level for their abilities – just like general educators do for all other students. They can also help students educators do for all other students. They can also help students learn to use scissors and pencils and write legibly (if they have the learn to use scissors and pencils and write legibly (if they have the ability to learn).ability to learn).

ReferencesReferencesBritish Columbia Department of Education. Special Education Branch, Ministry of British Columbia Department of Education. Special Education Branch, Ministry of Education. (1995). Awareness of Chronic Health Conditions: What the Teacher Education. (1995). Awareness of Chronic Health Conditions: What the Teacher Needs to Know.Needs to Know.

Center For Disease Control: National Center on Birth Defects and Developmental Center For Disease Control: National Center on Birth Defects and Developmental Disabilities . Disabilities . Cerebral Palsy. Cerebral Palsy. Retrieved on November 25, 2005.Retrieved on November 25, 2005. http://www.cdc.gov/ncbddd/dd/ddcp.htmhttp://www.cdc.gov/ncbddd/dd/ddcp.htm

Coubois, Y., Coello, Y., & Bouchart, I. (2004). Mental Imagery abilities in Coubois, Y., Coello, Y., & Bouchart, I. (2004). Mental Imagery abilities in adolescents with spastic diplegic cerebral palsy. adolescents with spastic diplegic cerebral palsy. Journal of Intellectual & Journal of Intellectual & Developmental DisabilityDevelopmental Disability, Vol. 29, 3, 226-238., Vol. 29, 3, 226-238.

Council for Exceptional Children: Information Center on Disabilities and Gifted Council for Exceptional Children: Information Center on Disabilities and Gifted Education. (2000). Retrieved on November 25, 2005. Education. (2000). Retrieved on November 25, 2005. http://ericec.org/faq/cerebral.html http://ericec.org/faq/cerebral.html

Dennis, M. (1995). Literacy and cerebral palsy: Factors influencing literacy learning Dennis, M. (1995). Literacy and cerebral palsy: Factors influencing literacy learning in a self-contained classroom. Journal of Reading Behavior, Vol. 27, 4, 627-642.in a self-contained classroom. Journal of Reading Behavior, Vol. 27, 4, 627-642.

Erickson, K. & Koppenhaver, D. (1997). Integrated communication and literacy Erickson, K. & Koppenhaver, D. (1997). Integrated communication and literacy instruction for a child with multiple disabilities. Focus on Autism & Other instruction for a child with multiple disabilities. Focus on Autism & Other Developmental Disabilities, Vol. 12, 3, 142-151.Developmental Disabilities, Vol. 12, 3, 142-151.

Hallahan, D. P. & Kauffman, J. M.(2006). Hallahan, D. P. & Kauffman, J. M.(2006). Exceptional learners: Introduction to Exceptional learners: Introduction to special education, 10th Ed. special education, 10th Ed. San Francisco: Allyn and Bacon.San Francisco: Allyn and Bacon.

National Institute of Neurological Disorders and Stroke. National Institute of Neurological Disorders and Stroke. Cerebral Palsy Information Cerebral Palsy Information PagePage. Retrieved on November 25, 2005. . Retrieved on November 25, 2005. http://www.nids.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htmhttp://www.nids.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm