Wednesday, April 29, 2015

Letters to Loved Ones

For Parents 
by Kevin,

An adult with hemiplegic cerebral palsy I can say what I am about to say perhaps only because my hemiplegia is slight--- affecting primarily my walk, left foot/leg size and the motor skills of my left hand. It was however severe enough to warrant four operations, years of braces, therapy, and ugly orthopedic shoes. While I feel that I got off lucky, the experience of hemiplegia not only scarred my life as a child, it in essence became my life. Here, though is the odd part: My disability, perhaps because I willed it to do so, changed my personality and the essence of who I am for the better. While it made me an outsider, it also gave me compassion for all outsiders. While it forced me to suffer physical pain, it gave me the ability to respect and empathize with the pain of others. While it drove me to the very depths of sadness as a child, I also learned early to laugh (at hemiplegia, at the slings and arrows of life) and have a strong, sardonic sense of humor that I carry to the present. While it made me different from other kids, it caused me to come to grips with the good things inside me that truly made me different and special. The final odd part: I am who I am in large part because of my disability. If some magical omnipotent entity came to me now (as I dreamed and hoped as child that someone would), within a few months of my 45th birthday, and said that it would remove hemiplegia from my life entirely --from the beginning--and with it all the changes in my being and personality that came with it, I would respond with a polite but firm "NO". I like whom I have turned out to be, funky walk and all, and I value too much what I have learned in my personal school of hard knocks. This is a personal statement, and applies only to me. I am not a masochist and, if my disability were greater, I am sure I would not respond with the "NO". I am humbled by the levels of pain and compassion and worry and hope and love on this list of parents of children who have hemipelgia. I sympathize, in a way few people can, with the pain that hemiplegia has caused you as parents who love your children. The things I have learned from hemiplegia are not gifts but silver linings amid dark clouds. I am a great believer in silver linings. I want to give you the thought that there might (and only might) be some small good things that your children have received or will receive in life, which may be linked in some way to hemiplegia. At least this is my hope.

Kevin

One Step at a Time
By Sam Troia

I spent a little more than nine months taking care of a boy who has cerebral palsy. 
This is Kaleb. 

Each day I worked with him I had the pleasure of picking him up from school and either going to therapy, or looking after him at home until his Mom had finished cooking dinner. I took him to therapy every Monday and Wednesday and over the nine months I was with him I learned so much. 

Kaleb outside of therapy

Kaleb has been wheelchair bound his whole life but his goal for therapy was to walk. I watched him overcome fear and frustration and be able to take steps on a treadmill and with different gatetrainers. 

Kaleb walking

But these days of success were also followed with pain, frustration, and doubt. I will never forget the day where Kaleb did not want to walk. Every other day he would get into therapy and he would want to start walking before his therapist even had a chance to say hello. But on this day, he did not want to do anything. He wanted to go home. He said it over and over again and we could not figure out what was wrong. We cut therapy short and on the drive home we sat in silence. Kaleb and I usually would play some sort of pretend, talk about our families, or sing, but not today. Today he just stared out the window while I drove him home. Once we got to the house I asked him again, "Come on buddy, you can trust me. What's up?" 
Tears started to fill his eyes as he looked away from me and said, "I'm scared." 
"Scared about what?" I asked.
"I'm scared that I will never walk." He stated as the tears began to roll from his eyes. 
My heart sank. I put my arm around him and held him for a minute. I spoke up and said, "I don't know if you will ever walk on your own buddy. I can't promise you that. But I can promise that your mom, dad, therapist, and me will not stop trying everything we can to try to get you to walk." He smiled, took a deep breath and said, "Let's play!" I gave him a big hug and said, "I'll get the Wii set up!" 

Even though I have stopped working with Kaleb, I will be working with him this summer.
I do have a message for him. 
Keep stepping. 
Every time you see your friends at recess running around you, keep stepping.
Every time you want to run away from therapy, keep stepping. 
Every time you doubt yourself, keep stepping. 
Because with every step you take, we will be right beside you. 
We will pick you up when you fall, laugh with you when you laugh, and step with you when you step. 
You will step. You can step. It is not going to be easy, and it will be frustrating, but you will not be alone. 

Sammy


Message to Patrick
from Carla MacInnis Rockwell, a 44 year old woman with cerebral palsy, to Patrick, and 8 year old boy with cerebral palsy 

      Hi Patrick, My name is Carla and I was 8 once ... a long time ago. I also have cerebral palsy. Not the same type as you, though. I have spastic diplegic cerebral palsy. That affects the way my legs move. 
      Your mom is right. CP happens in the brain. It's sorta like a big bruise that didn't go away. But at least we can walk, right? The summer of 1963, when I was 8 I had an operation on my knees to help me walk better. I used to wear huge heavy metal braces up to my waist with lots of straps. And the ugliest boots you ever saw. That was from age about 2 to 8. From age 8 to age 12, I wore ugly below the knee braces, and even uglier boots! From 12 til 28, I wore no braces. Yea! And regular shoes!! For a brief time when I was an adult, I wore braces again, but they were so awkward, I kept tripping over my feet. Guess where those braces are? ... In my closet!! 
      When I was growing up, I had 1 younger brother, 4 older brothers, and 2 older sisters ... big family. I learned how climb trees, ride a two-wheeler. Heck, I was even on ice skates. What a sight that was! I used to ask my parents why I had cp, just like you're asking your Mom. You know and I know that cp happens when a baby is born too soon, or its brain doesn't get enough oxygen. Stuff like that. But you know what, I like to think I have cp for another reason. That's so I can show people what I can do without two typical legs. 
      As you get older, Patrick, you will realize that it's what sits on top of your shoulders that is the most important thing. Develop your mind as much as you can. But don't forget all those exercises and things to make your legs and the rest of your body strong. Having cerebral palsy doesn't make you who you are, or who you will become. It's just a tiny part of you. Being kind to others, and understanding and gentle are far more valuable than running marathons will ever be. But ... you can still work hard so you might one day run a marathon. Anything is possible!! 
      Never forget, Patrick, there are lots of things you can do that don't need legs. A president of your United States had polio and ran your country during a period of war. A woman who could not hear or speak became a great writer and scholar, using sign language to communicate. 
      I am 44 years old, and I am a writer. Perhaps your mother could read some of the stories my terriers, Mr. Jake and Mr. Alex wrote. I hope you like them. I use the voice of my dogs to explain about disability. Funny how animals know I'm "different" in the way I move. Bet they are with you, too. 
       Asking questions about cp is a good thing, Patrick. Learn all you can about it, so that when people ask you, you can tell them. And don't be worried if people stare at you when you walk. Let them know that having cp isn't really such a big thing after all. You can be sort of like a teacher, telling people about what cp is and all about what you can and can't do ... yet. Hope you and your family have a great summer. And if you know how to swim, get lots of that fun stuff in. It will make your legs and stomach very strong! 

Cheers! 
Carla MacInnis Rockwell 



Resources for Parents with Children with Cerebral Palsy


Websites:

  • cerebralpalsy.org
  • ucp.org
  • http://www.friendshipcircle.org/blog/2013/11/06/20-cerebral-palsy-resources-you-should-know-about/
Government Resources
  • Cash assistance
  • Child Care assistance
  • Education Assistance
  • Employment Assistance
  • Energy Assistance
  • Health Care Assistance
  • Health Insurance
  • Housing and Rental Assistance
  • Nutritional Assistance
  • Safety and Protection

Cerebral Palsy Population



  • Cerebral Palsy is more common among boys than among girls 
  • More common among Black children than White children
  • Over half of the children identified with CP could walk independently. 
  • Many children have at least one co-occurring condition, mainly epilepsy. 







Early Signs of Cerebral Palsy:
  • Vary greatly because there are many different types and levels of disabilty. 
  • The main sign that a child might have cerebral palsy is a delay reaching motor or movement milestones such as rolling over, sitting, standing, or walking. 
  • Other signs include (cdc.gov):
    • If the baby is younger than 6 months:
      • His/her head lags when you pick him/her up while he/she is lying on his/her back. 
      • He/she feels stiff 
      • He/she fees floppy
      • When held, cradled in your arms, he/she seems to overextend his back and neck constantly acting like he/she is pushing away from you. 
      • When you pick him/her up, his/her legs get stiff and they cross or scissor. 
    • If the baby is older than 6 months of age:
      • He/she doesn't roll over in either direction
      • He/she cannot bring her hands together
      • He/she has difficulty bringing her hands to her mouth
      • He/she reaches out with only one hand while keeping the other fisted. 
    • If the baby is older than 10 months of age:
      • He/she crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
      • He/she scoots around on his buttocks or hops on his knees, but does not crawl on all fours. 

Special Considerations for People with Cerebral Palsy


  • Follow the FITT principle (Frequency, Intensity, Type, and Time). 
    • Modify the prescription to the patients needs and be aware of their limitations. 
  • Because of lack of movement control, energy expenditure is high even at low power output levels. What we might see as simple, can by very difficult. Pay attention to their words to see the difference between frustration, fear, and pain. 
  • Give time for recovery. Recover after every  time intensity level is exceeded. Shorter durations of exertion may be recommended to work at the optimal intensity and allow for the right amount of recovery time. 
  • Individuals with Cerebral Palsy will fatigue easily because of poor economic movement. 
  • Fatigue will severely affect the hypertrophic muscles and can deteriorate the voluntary movement patterns. 
  • To have a more effective training session, one must: 


    • Several short training sessions are conducted rather than one longer session
    • Relaxation and stretching routines are included throughout the session
    • New skills are introduced early in the session. 

  • Resistance training in individuals with Cerebral Palsy without an adverse effect on muscle tone. But this does not have a functional outcome. Focus more on flexibility training in conjuncture with any resistance training program. 
  • Remember to stretch before and after workouts. People with cerebral palsy need the cool down and warm up to prevent muscle soreness, blood pooling, and muscle tightness. 
  • The focus for working with children with cerebral palsy is on inhibiting abnormal reflex activity, normalizing muscle tone, and developing reactions to increase equilibrium. 

Cerebral Palsy Training Guidlines



Limitations: 
  • Motor control
  • Sensory disabilities
    • Vision
    • Hearing impairment, 
  • Cognitive disabilities
    • Intellectual disability
    • Perceptual Motor Disorder
  • Epilepsy
    • Occurs in 25% of those with CP

Exercise testing can be used to uncover challenges or barriers to regular physical activity, to identify risk factors for secondary health conditions, to determine the functional capacity of the individual. 

What to watch for:
  • Assessment of the trunk, upper, and lower extremities, range of motion, strength, flexibility, and balance. Use this information to choose the type of exercise equipment, protocols, and adaptations. 
  • Use adaptive equipment to assure safety and proper technique as seen in the picture above. 
  • Tailor the work out to the needs of the patient. 
                                           (Working on stretching the muscles on the inner thigh and trunk strength)

  • Maximal testing cannot be generalized. Because of that you should test new patients at two or three sub-maximal levels. 
  • Movement during these sub-maximal workloads should e controlled to optimize economy of movement. 
  • In individuals with moderate and sever Cerebral Palsy, motion is considered a series of discrete bursts of activity. 
    • Can assess anaerobic power derived from the Wingate anaerobic test to determine the potential of the individual. 
  • Individuals with Atheoid Cerebral Palsy, strength tests should be performed through closed chain machines. 
  • In children with Cerebral Palsy, eccentric strength training increases eccentric torque production throughout the range of motion while decreasing electromyographic (EMG) activity in the exercising muscle. 

What is Cerebral Palsy?

Cerebral Palsy is a non-progressive lesion on the brain occurring before, at, or soon after birth that interferes with normal brain development.

This is caused by damages to areas of the brain that control and coordinate muscle tone, reflexes, posture, and movement. 


Main two types of Cerebral Palsy are Spastic and Athetoid. Spastic is characterized by an increased muscle tone typically involving the flexor muscle groups of the upper extremity and extensor muscle groups of the lower extremities. Athetoid CP is characterized by involuntary and/or uncontrolled movement that occurs primarily in the extremities.  


People with Cerebral Palsy will struggle with reflexes, they will be delayed or completely absent. Severely involved individuals with CP may primarily move in reflex patterns, whereas those with mild involvement may by only hindered by reflexes during extreme effort or emotional stress.