The Exceptional Child

Cerebral Palsy

Produced for the Educational Television and Radio Center by Syracuse University, 1969

Statement and Disclaimer from Thomas Neuville, Associate Professor, Department of Special Education, Millersville University

Speaker: Bobby, I'd like you to draw a picture just like this one on this sheet of paper.

[ No audio ]

Speaker: Uh-huh. All right. Go ahead and finish it.

Bobby: Make it, too?

Speaker: Uh-huh. All right. Now would you like to try it on this sheet of paper? Draw another one just like it for me.

Narrator: This child has cerebral palsy, one of the most complex conditions with which mankind is confronted.

[ Music ]

Narrator: "The Exceptional Child, a child with differences. It is our hope that through these programs, we might better understand this child and help him.

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Narrator: This is Bobby, and here he is with Dr. Donald Y. Miller, Research Associate in the Education of Exceptional Children at Syracuse University. Dr. Miller is a psychologist, one of the many professional men and women who must combine their efforts to understand the child with cerebral palsy and plan for him.

Psychologists, physicians, special therapists, social workers and teachers represent a cooperative team which must join Bobby's parents in a total effort to help Bobby achieve a satisfactory degree of self-respect, confidence and adjustment to those around him.

I'm Ed Jones, your host on these programs, and today we're going to meet some of the dynamic and tremendously challenging problems that confront the child with cerebral palsy.

There are few conditions in human beings that are more complicated than that of cerebral palsy. It is not a single condition or disease but, rather, a multiple and complex combination of disabilities and resulting frustrations. So that it is at once a medical, psychological, economic and sociological problem.

Here with us today to help us to a clearer and more constructive understanding of the child with cerebral palsy, we have Dr. William M. Cruickshank, Director of Education for Exceptional Children at Syracuse University.

Dr. Cruickshank: Cerebral palsy has been known to the medical and psychological professions for many, many years, but it is only since approximately 1940 that all of the professions concerned with this disease have focused their attention seriously upon it. This has been due primarily to the stimulus which the tens of thousands of parents of cerebral palsy children have brought to bear on the problem.

Cerebral palsy is a long-term, non-fatal, non-curable disease or condition, as it is more frequently referred to. It occurs in about 7 out of every 1,000 live births in the United States. It's an injury to the brain or to the central nervous system.

Cerebral palsy may occur before the child is born, during the months that the mother is carrying the baby, or it may occur during the birth process, although this is not as frequently the case as sometimes has been stated. Or it may occur during the few years immediately after the birth of the child.

Cerebral palsy usually results in one but sometimes two major problems. The first is physical. Bobby Mantell, who is here with us today taking a psychological examination, demonstrates both of these problems. Bobby shows a marked physical disability. His legs are seriously crippled. His arms are not quite so involved.

Bobby, however, also shows some very marked psychological problems. He is hyperactive, very distractable, he has a very short attention span. These things will serve to be real hurdles to his learning and achievement, unless the therapist and educators who are working with him take special precautions to provide the type of setting that is so important for Bobby. This they are doing.

Mr. Jones a moment ago referred to the fact that cerebral palsy is complex. This is certainly true. There is no condition in childhood which is more complex than is cerebral palsy. Complexity is certainly the keynote to this condition.

Narrator: The complex nature of cerebral palsy can perhaps be best understood by visiting with a group of children in their clinic. They're here in a small social group ready to go to their various individual therapy rooms.

About 30 to 40% of all children with cerebral palsy also have some form of epilepsy. Larry, who is three and a half years old, is severely disabled and has a type of epilepsy which has yet to be brought under control by his physicians. Thus, his therapy program is almost completely at a standstill. A seriously disabled child, Larry has a long way to go and an uphill pull is ahead of him.

Rosalind is 4 and is a little cerebral palsy girl whose legs and arms are disabled. However, her legs are more seriously crippled. Her outgoing personality is a real asset to her. Therapists and attendants alike respond warmly to her and provide her with a secure, wholesome atmosphere for adjustment.

Kenny, who's nearly three, also has cerebral palsy. He has one good arm and one good leg. One half of his body is disabled. Tommy's rather mild physical problem is complicated by a hearing loss. About 10% of all cerebral palsy children have hearing disabilities, too. A most important factor in his growth is a development of speech since, because of his hearing loss, speech is impaired, also. With this boy, all four extremities are disabled. His treatment is complicated because he comes from a home where only French and Polish are spoken.

This pert little girl is Lisa. Her arms and legs are all moderately disabled. She also has a severe visual condition called strabismus and popularly known as cross-eyedness. About 8% of cerebral palsy children have serious visual problems.

Bobby has little or no use of his legs but some limited use of his arms. He's learning to fall without hurting himself. The close relationship between Bobby and the physical therapist, which is so necessary, is typical of all treatment situations with cerebral palsy children. It emphasizes the need for well-adjusted and patient professional adults.

Gloria represents another complex problem in a complex field. Gloria, whose speech and hearing are excellent, is totally blind. Her level of intelligence is not accurately known. She has good use of her hands but little, yet, of her legs. Her blindness, a major handicap in itself, will significantly retard the treatment program but will not completely interfere with her progress.

Legs, arms, the total body or parts of it, eyes, ears, speech, any or all may be handicapped in mild degree or in degrees of utmost seriousness.

Dr. Cruickshank: In addition to the many physical variations in cerebral palsy, there are two other factors which add to the problem of complexity. The first of these is the matter of mental subnormality. Recent studies in the United States and in England have indicated that between 50 and 75% of all children with cerebral palsy have some degree of mental subnormality. Not all of these are grossly mentally deficient but all of them are mentally retarded. This fact adds to the seriousness of the problem for mental subnormality will have its influence in all aspects of the treatment and training program which is planned for these children. Therapists, educators, psychologists, must always take this factor into consideration.

The second major problem is the problem of the great number of clinical types. There is more than a dozen different medical classifications of cerebral palsy, each of which has to be considered separately. The three, which account for the greatest number of children, are those known as spastic, athetoid and ataxia.

Narrator: Of all the medical classifications of cerebral palsy, spasticity is the most common. Since it is so common, the spastic group oftentimes, but erroneously, gives it name to the total problem.

Just how many spastic children there are is unknown. Nevertheless, the group accounts for almost half the total number of children with cerebral palsy.

Bobby is a spastic cerebral palsy boy. Spasticity results from an injury to the central nervous system. Random actions occur whenever movement is consciously attempted. Bobby looks almost like any other child, except when he consciously tries to do what he's told. When asked to button a button, zip a zipper, open a shirt, buckle a buckle, Bobby is observed to become quite tense and to engage in numerous, uncontrolled movements, which, in his case, involve his hands, his legs, indeed, his entire body.

Although Bobby's physical problem is relatively mild, his attention span is very short. He is hyperactive and easily distracted. To be a socially acceptable individual in the community, to be respected by other children and the adults who surround him, Bobby must learn certain skills that are almost taken for granted in physically normal children.

To button his shirt is a complicated and difficult job. To struggle with pants' buckles and zippers is a mighty task, the learning of which takes the combined energy of Bobby and his ever-patient occupational therapist. But, learn them he must, for the degree to which he is accepted as a participating member of his group will be measured in large degree by how well he can do the things which all children of his age do.

The therapist must continually evaluate Bobby's progress in order to determine her own plans for him. While buttoning and shirts seem to be within his grasp, the problem of removing trousers and other tight-fitting clothing is a self-help task which is yet somewhat beyond him. His legs are members of his body over which he still has too little control. More work, more patient work by his therapist and parents is obviously indicated. Bobby's smile will carry him a long way but the encouragement of that smile is the job of those who work near him day by day.

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Narrator: Another type of cerebral palsy is called athetoid. The athetoid child also has suffered a damage to the central nervous system, the characteristic aspects of which is continuous, involuntary movement. Joan shows a continuous, random movement of her hands and head. Her legs would likewise be moving were it not for the firm steel braces and the leather lacing which keeps them fixed.

Children with athetosis respond by increased involuntary movement to emotional tension, rage, fear, happiness. Love and anger will be observed to increase the athetoid movement. The continuous movement is irritating to the child and she attempts to control the movement by exerting pressure and becoming taught.

Joan's fingers are tightly clenched. Because by keeping them shut, she no longer is bothered by movement. A door slams and Joan is startled. Her random movements quickly increase. The speech therapist moves rapidly to brace her legs against the child to reduce the emotional tension. Sandbags are placed over the child's hands to help Joan regain control over her arms.

Speech cannot be developed if she's distracted by moving arms and legs, and speech must be developed. Speech is going to be Joan's key to successful adjustment. As many as 80% of athetoid children will have speech disabilities in addition to their physical problems. Feelings about a person, attitudes toward him and his own attitudes toward himself are oftentimes a reflection of his speech patterns.

In children with cerebral palsy, much time is placed upon the development of speech and language. The speech therapist is an important person in the development of wholesome and socially acceptable speech patterns in this child.

Rosalind has much in her favor, but she also has a serious problem. She has much work to do, up and down, day after day, working against pressure. The monotony becomes great and the work can become tedious. She does have much in her favor, however. Her pert hairdo and her spotless white hair bows, her wonderful smile, all endear her to her physical therapist and the others with whom she works each day.

Rosalind has a type of cerebral palsy called ataxia. This condition is characterized chiefly by an inability on the part of the child to select the proper force with which to initiate movement. Her inability results in a clumsy gait and uncoordinated hand movements. To give Rozzie as great an opportunity as possible to be treated as a normal child, the physical therapist is giving her extensive exercises in the maintenance of balance. She must learn to balance herself as a conscious exercise, although for most boys and girls, the time when balance was learned is something forgotten in the past of a very early childhood.

People who do not understand frequently think that older men and women are intoxicated when they observe them on the street, but, in reality, such an individual may be an ataxic cerebral palsy adult. Judgments of this type are so frequent as to be expected by individuals with cerebral palsy, but, nonetheless, such judgments are difficult to accept, or to be looked upon as healthy by those who are disabled.

For Rozzie to be able to maintain her balance and to walk without a noticeable gait or stagger will mean that she will be more adequately accepted by her neighbors and by the society in which she lives. A clumsy gait will cause ladies to turn later on as she passes in the street. When she's older, some unthinking bus driver may refuse her admission to a bus for fear that she's intoxicated. She must walk without a stagger. As a young lady, waiting for a taxi, she may be passed by for a better fare. She must walk as others walk. This is her goal. Rozzie's remarkable personality will carry her far but the work of the physical therapist and the other specialists in her clinic is absolutely essential if she is to present to society the appearance of normality.

Dr. Cruickshank: The physical characteristics of cerebral palsy are only one aspect of the problem. The social adjustments which cerebral palsy involves for all members of the family are equally important, for brothers and sisters, for father and mother. Mother frequently is unable to go out in the afternoon as frequently as she would like to because she must stay home and take care of the physical needs of her child.

Father and mother are restricted to their home in the evening because they are unable to find another adult who will come in and take care of a seriously disabled child. Neighbors, likewise, are frequently unthinking in their attitudes and their gestures and facial expressions towards cerebral palsy children. Neighbor children are frequently not permitted to play in the home where a cerebral palsy child lives. These problems are daily faced by parents of cerebral palsy children and complicate the adjustment process.

Mother: Mommy's going to get your lunch now, Joni. You just be a good girl and Mommy will be right back.

Come on, Joni, we've got to hurry. Mr. Fellows will be here any minute to take you to school. You kept Mommy so busy today. I wish that just once we could be ready on time. Oh, doll, Mommy didn't mean it that way. It's just that -- well, we don't want to keep Mr. Fellows waiting every time, do we?

Oh, Joni! That rug just came back from the cleaners! Don't you know it cost money?

[ Knocking at door ]

Mother: See, there he is. Now you'll just have to go without the rest of your lunch. Sometimes I could -- oh! Here. All right, now, forward.

[ Knocking at door ]

Mother: (Softly) Oh, I'm coming.

Not right. Sit forward. Sit forward. There it goes. That's a girl. Now button it. Your hat. Oh, no!

[ Knocking at door ]

Mother: (Softly) All right, all right. There you are.

[ Knocking at door ]

Mother: All right. Here we go. That's a girl.

Dr. Cruickshank: Glen Fellows is a college student employed to drive Joan to the clinic. He is not familiar with cerebral palsy. He has relatively little interest in children. He is using the job merely as a means of getting through college. His contacts with Joan are minimal. He converses with her hardly at all. Insofar as Joanne is concerned, he is the great stone face who is not really interested in her.

Mother is frustrated being so tied down with Joan's helplessness. At the same time, she feels guilty at being the parent of a child with cerebral palsy. Guilt, frustration and the realization that Joan, while possessed of good mentality, will always be dependent, leaves Mrs. Barlett to fear the future.

Joan's mother is a good mother insofar as Joan's care is concerned. She has pretty dresses and clothing purchased in keeping with the family budget. She's not over-indulged. She is, however, overprotected to the point where, indeed, her life is not her own.

Pecking and poking like a mother hen, Joan's mother mistakenly believes this overattention will resolve her guilt feelings and provide Joan with a love that is not wholly there.

What is the impact of this confused emotionalism on Joan? Cold, impersonal reactions of the driver, smothering oversolicitude from the mother. This inconsistency is not a wholesome environment for Joan.

The car moves away. Joan is gone for another few hours. In the moments which are her own, as she trudges up the hill, Mother is free to her own thoughts, free from the constant reminder of Joan's physical disability, free from Grandma's numerous queries as to why Joan was born that way.

Mother thinks, who is responsible? Why did it happen to me? What caused it? Sometimes the breaking point is awfully near for this parent.

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[ Phone ringing ]

Mother: Hello. Oh, hello, Edna. No, I just got Joni off to school. Been one of those days. What? No, I don't see any improvement. Sometimes I think I can, and after days like today, I just... help more? Edna, you don't know how I would love to do just that. Fashion show? Oh, sounds wonderful. When? Oh, no, Joni will be home from school before that. Oh, no, getting a sitter for a child like Joni is just impossible. I would spend the whole afternoon trying to get one and, even if I did, she wouldn't understand Joni. I'd worry the whole time I was away. No, thanks, Edna. Do have a good time. No, I'm -- I'm sure. Yeah. Bye. Aha, come over some evening after Joni's in bed. Bye, Edna.

Father: Betty, how about another cup of coffee?

[ Liquid pouring ]

Father: Gosh, I wish we didn't have to eat so late. It would be nice if we could eat altogether, you know, like a family.

Mother: Oh, Phil, don't bring that up again. Same old thing every night.

Father: Well, it would be nice.

Mother: Nice, yes, nice. If you could spend one day taking care of that child, you could see how nice it is.

Father: I know, dear. I would like to afford some help for you but, well, until I can...

Mother: Edna called, how would I like to join her and some of the others downtown for a fashion show?

Father: I know, Dear.

Mother: By the time I get Joni in bed, it's too late to have guests in or -- I'm so tired and defeated. Today, when I was trying to feed her her lunch, you should have seen it, the rug -- I tell ya, Phil, it's awful, it's just awful. I tell ya, you can send her away any time you want. I don't care if I never see her again!

Father: Betty, Betty, you don't mean that!

Mother: It was my fault. Was it my fault she is the way she is?

[ Crying ]

Mother: Oh, Phil, Phil, what are we going to do?

Dr. Cruickshank: There is no single answer to families with cerebral palsy children. This is a long-term, incurable problem. It's a lifespan problem. This problem is one with which the parents are going to have to deal all during the life of the child.

The cerebral palsy child is going to grow and mature like all other children, of course. Going to pass from infancy to childhood and childhood to adolescence and on into adulthood. But the fact of cerebral palsy is always going to remain, for this is incurable.

The picture is not entirely a gloomy one, however, for many cerebral palsy children. There are thousands and thousands of agencies throughout the country, staffed with highly trained professional people which are bringing their skills to bear on the cerebral palsy child and his family each day. The goal of these agencies is not to cure an incurable condition but to bring the child to the highest level of skill and activity and function that they possibly can.

And then the problem of the community is to see to it that these children and their families are accepted in order that the children themselves, as young adults, can live happy, normal, satisfying lives within the limitations of their physical disabilities. This is our goal and this can be accomplished in many instances.

Narrator: Every child has his own pattern of growth. When a child has a complex handicap, or combination of disabilities, his attempts to satisfy his needs and take his place with others in the community may be severely restricted and frustrated. The child's parent will also need help, from physicians, teachers, therapists, social workers, and psychologists. And from a society that will accept him and assist him and his parents in their adjustment to the complex problems they face.

Work with children with cerebral palsy is endless, for each child is different and what helps one child will not necessarily help another child with similar conditions. However, it is up to all of us to do whatever we can to help, for children with cerebral palsy are as much a part of our society as any other children, and our happiness is in part dependent on theirs.

Next week, we shall try to understand the relationships of the child with chronic medical disorders. Remembering that a child with a handicap is yet a child, an exceptional child with a life that may be restricted, sometimes even distorted, but one which can grow toward some degree of fulfillment.

As we know more about the growth and development of children with handicaps, we will be able to help the exceptional child more in his quest for happier, more secure relationships in life. With the hope that if he cannot completely eliminate his handicaps, he may effectively reduce the restrictions they cause.

The child is born, new life begun, a life that may be exceptional but need not be without some degree of fulfillment and happiness.

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Speaker: This is National Educational Television.