Cerebral Palsy

The term Cerebral Palsy describes:
A group of developmental disorders with mobility and posture causing limitation of activity, attributed to non-progressive troubles in fetal development or in the immature brain. The motor disorders of Cerebral Palsy are frequently accompanied by disturbances in sensation, cognition, communication, perception, comportment, epilepsy and secondary muscular-skeletal problems (Rosenbaum, Paneth, Leviton, Goldstein & Bax, 2007).
The global incidence of Cerebral Palsy is approximately from 2 & 2,5/1000 newborns (Kumari & Yadav, 2012), allowing for that, in Portugal, the most recent data collected in the 2001 Census points to the existence of 15 009 persons with Cerebral Palsy (PORDATA, 2001). The impact CP can have on a person’s life, ranging from slight difficulties to severe limitations with participating in day-to-day life, carries on for all of their life.

Cerebral Palsy can be of different types

Nowadays it is commonly held that the social participation, involvement and  functionality of persons with Cerebral Palsy depends, above and beyond their condition, on the opportunities that their environment offers, assuming these opportunities to be a presence in the quality of life ever since birth. This view, as stressed in the Biopsychosocial Model, accentuates the blending of different health criteria (i.e. biological, individual and social), and constitutes a WHO (World Health Organization) recommendation, as laid out in the creation of the International Classification of Functioning, Disability & Health (ICF), approved in 2001 by the United Nations Organization so as to recommend its adoption by the WHO.

The dissimilarity of troubles covered by the term Cerebral Palsy, as well as current advances with the investigation and comprehension of human development, emphasize the importance of neuroplasticity with the treatment of these individuals. Allowing for the fact that neuroplasticity is greater in the early years of life, treatment at infancy becomes vital. This constitutes a determining factor, with regard to minimizing the results of cerebral injury and prompting brain reorganization, as well as in making progress with functionality in the affected areas (Arguelles, 1996; Bax, 2000; Miller & Bachrach, 2006).

Cerebral Palsy can affect different parts of the body

Consequently, modern infant treatment programs, based upon a bioecological approach to human development, emphasize specific aspects of a person’s development, above and beyond stressing the family and community environment the infant is placed in, allowing for a contextualized study of its development and of the program’s own impact in the contexts of the infant’s life. The rehabilitation process must be one of ongoing perspective, fitted and adapted to each and every stage of the individual’s life.

Contemporary literature outlining rehabilitation services for persons with Cerebral Palsy accentuate three major notions:
  • Stressing family-centered service, encouraging decision making as a collaborative process between the family, the child and the professionals, communicating respect for the legitimateness of each and every family circumstance; 
  • Stressing therapeutic goals focused on making the child capable of completing useful activities which are significant for the child and valuable for the family;
  • Cerebral Palsy is a permanent condition and not just a childhood ailment, with significant transitions and periods of change throughout life (Darrah, Wiart, Magill-Evans, Ray & Anderson, 2010).
With regard to the value of a family centered approach, one should stress that it is currently recognized by specialist pediatric services as the most effective approach (Almasri et al., 2011; King et al., 2004; Lotze, Bellin & Oswald, 2010). This complements a holistic vision, both personalized  and dynamic, of providing support  with an appreciation of the strengths, resources and needs of each family (Dunst, Trivette, Cornwell & Davis, 1994) in a collaborative process between parents and professionals, sharing goals, information and responsibility (Granat, Lagander & Borjesson, 2002; Neff et al., 2003).

Cerebral Palsy associated impaiments
In accord with the aforementioned references, one should also mention that, in recent studies undertaken with inhabitants with Cerebral Palsy, it is strongly suggested that approaches centered on intensive therapy might not be recommended for these groups, especially if such therapies are not linked to their actual needs (Andrada, 2003).

Almasri, N. A., Palisano, R. J., Dunst, C. J., Chiarello, L. A., O`Neil, M. E. & Plansky, M. (2011). Determinants of needs of families of children and youth with Cerebral Palsy.
Andrada, M. G. (2003). Paralisia Cerebral - Etiopatogenia/Diagnóstico/Intervenção. Arquivos de Fisiatria, 37, pp. 5-16.
Argüelles, P. (1996). Parálisis Cerebral. In M. Puyuelo, P. Póo, C. Basil, e M. Métayer (Orgs.), Logopedia en la Parálisis Cerebral: Diagnóstico y Tratamiento (pp. 1-16). Barcelona: Masson. Bax, M. (2000). Aspectos Clínicos da Paralisia Cerebral. In N. Finnie (Orgs.), O Manuseio em Casa da Criança com Paralisia Cerebral ( pp. 8-18). São Paulo: Editora Manole. Buran, F., Sawin, K., Grayson, P. & Griss, S. (2009). Family Needs Assessment in Cerebral
Children with Cerebral Palsy and their Families: A review of the Literature. Seminars in
Children`s Health Care, 40 (2), 130-154. Darrah, J., Wiart, L., Magill-Evans, J., Ray, L. & Anderson, J. (2010). Are family-centred principles, functional goal setting and transition planning evident in therapy services for children with cerebral palsy?Child: Care, Health and Development, 38 (1), 41-47.
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Granat, T., Lagander, B. & Borjesson, M. C. (2002). Parental Participation in the habilitation process – evaluation from a user perspective. Child: Care, Health and
King, S., Teplicky, R., King, G. & Rosenbaum, P. (2004). Family-Centered Service for
Kumari, A. & Yadav, S. (2012). Cerebral Palsy: a mini review. International Journal of Therapeutic Applications, 3, 15–24.
Lotze, G. M., Bellin, M. H. & Oswald,D. P. (2010). Family-Centered Care for Children With
Miller, F., e Bachrach, S. (2006). Cerebral Palsy: A Complete Guide for Caregiving (2ª Ed). Baltimore: Johns Hopkins University Press. 
Neff, J., Eichner, J., Hardy, D., Klein, M., Percelay, J., Sigrest, T. et al (2003). Family Centered care and the Pediatrician´s role. Pediatrics, 112, 691-696.
Palsy Clinic. Journal for Specialists in Pediatric Nursing, 14 (2), 86-93.
Pediatric Neurology, 11 (1), 78-86. Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., & Bax, M. (2007). Definition and classification of cerebral palsy. Developmental Medicine & Child Neurology, 49 (S109), 8–14.
Special Health Care Needs: Are We Moving Forward? Journal of Family Social Work, 13 (2), 100-113.

Images: images utilized are available in an infography created by the World CP Day (worldcpday.org).