Category Archives: Treatments and Therapies

Psychotherapy for Children Diagnosed with Cerebral Palsy

By Drew Dillard

The causes of cerebral palsy (CP) are both many and unknown, and no two people diagnosed with CP endure identical situations. However, at one point or another, nearly all people with cerebral palsy will face emotional and psychological challenges regarding the limitations CP has placed upon them. Let’s explore the types of psychotherapy available and how they might benefit your child.

Psychotherapy

Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a patient in an effort to improve that person’s sense of well-being, coping skills, communication skills and general disposition in the navigation of life’s challenges. It is different from therapeutic disciplines such as physical, speech & language, music & dance, occupational and play therapy, but is an important part of the overall care plan for your CP child.

Behavioral Therapy

Behavioral therapy uses psychological techniques that encourage the mastery of tasks. It is rooted in the belief that responses to emotional challenges and negative behaviors are learned and can therefore ne changed through therapy. Children do not yet possess the cognitive ability to process all that goes on with their thoughts and emotions, much less the ability to clearly communicate them. Psychotherapists are trained in identifying troubling situations, helping that child explore the thoughts, emotions and beliefs surrounding that situation, then helping the them acquire skills that will allow them to respond in a more effective and beneficial manner.

The activities used in behavioral therapy vary greatly depending on the abilities of the child and the problem behavior being addressed. Activities can be designed to teach completing tasks, managing emotions, resolving conflicts, delaying gratification and any number of other basic life skills. Behavioral therapy can help alleviate depression, mood swings, sadness, loss, anger and frustration by allowing previous negative outcomes to be replaced with a more positive perspective.

Counseling or Talk Therapy

As they get older, children with cerebral palsy will likely feel ostracized by peers, isolated from friendships, embarrassed by body image and/or frustrated with treatment goals. This may be a good time to introduce them to “counseling” or “talk therapy,” where they can talk about the things that are bothering them and learn to put them in perspective. It differs from behavioral therapy in that the goals are more along the lines of learning to accept and embrace one’s individuality rather than of raw behavior modification.

Even the most “normal” young person faces daily psychological and emotional challenges. Your hopes for your child at this age won’t differ much from that of any other parent. You want your child to cultivate a healthy attitude toward his or her challenges and to acquire the basic tools that will carry them into adulthood.  Many adolescents and teens see therapists to help process these complicated years. The right therapist can work wonders.

Social and Group Therapy

Individuals with physical or cognitive limitations often face real, and sometimes self-imposed, challenges in building relationships. Difficulties in communicating, fitting in or feeling accepted can lead to delays in social, emotional and even physical development.

Social therapy, introduced in the late 1970’s, helps children learn and embrace strategies that will help them develop friendships as they grow older by participating in group therapeutic settings. This decreases their sense of loneliness, isolation and stress. Social therapy focuses on the health and welfare of the individual as an integral part of a group dynamic. This relational approach helps children integrate into society and understand their role within.

Children with Mild Cerebral Palsy

Mild forms of cerebral palsy are often more difficult to detect and diagnose. Sometimes this leads to missed opportunities to introduce early-intervention corrective treatments, including those of a psychological nature. Undiagnosed abnormalities are often more emotionally troubling than diagnosed ones. If a child’s family and doctors don’t know what’s going on, it can be frustrating and confusing for the child.

A child that only exhibits minor physical impediments, such as issues of balance and coordination, may be completely normal in every other way. This can easily affect the child’s self-esteem. Also, children with minor physical or intellectual limitations are actually more likely to be teased and bullied for it than a child with an overt disability. Likewise, recent studies have shown that children with even minor learning disabilities benefit as much from treating the emotional component of the condition as with remediation of the learning disability itself.

It Takes a Village

It is important that parents and caregivers remain fully involved in the child’s therapies, especially with pre-teens. Caregivers need to understand and practice the positive behavior modifications learned in therapy to be able to recognize attention disorders, identify stressors, prevent meltdowns and minimize triggers all in an effort to reinforce a child’s progress.

Parents, caregivers and children with CP can all benefit from the positive interactions achieved with psychotherapy to compassionately, respectfully and appropriately interact with each other in a stable, secure and happy environment.

Resources

American Academy of  Pediatric Neuropsychology

Mayo Clinic Cognitive Behavioral therapy

Neuropsychology Frequently Asked Questions

Join Our Family

Sign up for our free e-newsletter for more blogs, articles, and news about CP kids and their families.

What to Expect From Your Occupational Therapist

By Lee Vander Loop
CP Family Network Editor

Occupational TherapistOccupational therapy (OT) and rehabilitation deals primarily with the many muscles responsible for wrist, hand, and finger movements, muscles involved in facial expressions, and tongue movement and swallowing reflexes. Occupational therapists are trained in the rehabilitation of these muscle groups to help patients acquire or improve daily living skills needed for self-care, work, and play.

Occupational therapy uses a regiment of exercises, adaptive equipment, and training to help a child achieve the fine motor and life skills needed in work and play, further assisting a child in realizing goals and independence.

This type of therapy can be especially helpful to children with cerebral palsy, but any child experiencing challenges with swallowing, using eating utensils, holding and manipulating a pencil, dressing, or playing with small objects will benefit from occupational therapy.

 

Challenges with Cognitive Motor Skills

Many children with cerebral palsy struggle with cognitive and motor skill challenges. Imagine the frustration of a child unable to hold a ball, manipulate a small toy, use a pencil in the classroom, or assist in self-care, hygiene and dressing tasks due to motor skill limitations. Early intervention and management of these issues is critical in early childhood development. Left unaddressed, the absence of these life skills can lead to severe developmental delays, a diminished quality of life, and a severely compromised level of independence. Additionally, a child may exhibit behavioral issues as a result of frustration due to limited abilities.

 

What to Expect from Your Child’s Occupational Therapy/Therapist

When working with your child’s occupational therapist, you should be made to feel like a part of a team. It is a team approach between you, your primary care physician, the therapist, and your child. You should be able to expect from your therapist:

 

Open Communication

Your child’s occupational therapist should communicate openly with you about what he or she is doing, what muscle groups are being worked with, and why a given approach is being taken. You should also expect the therapist to communicate with your child. Many young children are anxious and fearful around strangers. The therapist should be working and communicating with your child to earn your child’s trust and confidence. Regardless of your child’s level of comprehension and ability to communicate, the therapist should treat them with respect, patience, and compassion. If you meet a therapist who treats your child like an object and not a human being, FIND ANOTHER THERAPIST!

 

Compassion and Patience

You have the right to expect compassion and patience from your child’s therapist. If you feel a therapist is being overly aggressive and it seems to traumatize your child . . . STOP THEM.

The term “no pain, no gain” DOES NOT apply to children with cerebral palsy. Effective occupational therapy should not be painful or traumatizing to your child. If a therapist is being overly aggressive and causing discomfort, this is counterproductive and will result in your child associating therapy with pain.

 

Teaching

The physical therapist is not only working with your child but should also be teaching you so that you can be consistent in your child’s care and contribute to helping your child achieve and maintain goals in the absence of the therapist.

 

Accountability

Your child’s therapist should have written goals that are individualized and very clear. You should be provided with the results of the first assessment and goals the therapist hopes to achieve in addressing issues and challenges your child may be experiencing.

The therapist should take periodic measurements to assess your child’s range of motion, provide you with goals for improvement and notify you of progress or regression. Perhaps your child has limited range of motion in his/her lower wrists and hands; the therapist should provide you with goals for achieving better range of motion and a timeline for achieving those goals.

 

Coordination

You have the right to expect your child’s therapist to work and coordinate with your child’s educators in developing an Individualized Education Program (IEP) and to be an active member of your child’s IEP team. When working with a therapist not associated with your child’s school, the therapist should be communicating with your child’s educators and involved in the IEP process to ensure that the goals created are being worked on in your child’s educational setting.

The therapist should also be coordinating and communicating with your child’s primary care physician in obtaining physician’s orders for any needed adaptive equipment, devices, or other OT supplies. The therapist should keep the physician informed of your child’s progress or regression.

If the therapist feels your child would benefit from custom-made hand splints or other adaptive equipment, it’s the responsibility of the therapist to communicate with the physician that need and to follow up in acquiring the custom and adaptive equipment deemed medically necessary.

 

Continuity of Care

You have the right to demand, and the therapist has an obligation to provide, continuity of care in relation to your child’s therapy. Continuity of care means the same therapist works with and follows your child throughout the duration of the therapy process until your child either no longer needs the therapy and has reached the goals, or it’s determined that your child has achieved the maximum benefits of the therapy.

If your therapist belongs to a group and they send a different therapist for each session, this is NOT ACCEPTABLE.

 

Questions to Ask Your Therapist

Communication works both ways. You should be communicating any concerns and questions you have to the therapist. If necessary, keep a journal and note problems and challenges you see that your child may be experiencing between therapy sessions.

• Ask the therapist what you can do between therapy sessions to help your child maintain any progress achieved.

• Ask how often you should work with your child and the duration of each session.

• If your child has been prescribed adaptive equipment, ask how often you should use the equipment and the duration of each session.

• Ask about what adverse issues or side effects you should be aware of. For instance, if your child uses hand splints, you should watch for signs of skin breakdown and issues that would necessitate an adjustment in the device/equipment.

 

Resources

The American Occupational Therapy Association, Inc.

National Rehabilitation Hospital

National Survey of Pediatric Experts Indicates Increase in Infant Delays

Speech Therapy: Vital To Opening a Child’s World

By Lee Vander Loop
CP Family Network Editor

Years ago, before the invention of augmentive communication devices, children who displayed an inability to communicate were assumed to suffer from severe developmental disabilities and treated as such.

Imagine the heartache and frustration of a child with sound cognitive abilities or mild to moderate learning disabilities trapped in their body as a result of their inability to communicate. Augmentive communication devices have opened doors and given new lives to many individuals, providing a means of speech communication for those who would otherwise have no means of expressing themselves and their needs. Thankfully, speech therapists and augmentive devices are common today and can help most any child communicate in some way with the world around him or her.

The Basics of Speech Therapy

Speech therapy is the treatment of communication disorders, regardless of the origin. Therapists that work in the field of communication disorders are known as speech therapists and speech-language pathologists. Therapy can consist of a series of exercises and drills to strengthen the muscles involved in speech, and improve oral motor skills needed for speech as well as swallowing. Speech therapy may also include sign language and the use of picture symbols or augmented and alternative communication devices.

Many children with cerebral palsy experience some level of challenge with speech. Their challenges could be due to cognitive delays as in the case of mental retardation and learning disorders, or may be the result of damage to the area of the brain that facilitates speech. The speech center of the brain is referred to as the Broca’s area and is located in the left side of the brain for right-handed and most left-handed people. Nerves from the Broca’s area lead to the neck and face and control movements of the tongue, lips, and jaw.

Children learn speech from parroting what they hear in their environment. Children with hearing disabilities also experience challenges with speech because they cannot clearly hear sounds they and those around them are making. Children with cerebral palsy and speech challenges also commonly suffer from feeding disorders. Therapy to strengthen speech muscles also greatly benefits eating and swallowing.

Issues Involving Specific Types of Diagnosis

With children diagnosed with spastic cerebral palsy, muscle tightness (hypertonia) may cause the tongue to constantly push up against the roof of the mouth, or palate, making speech all but impossible. Children diagnosed with hypotonia (low muscle tone) likewise would experience challenges with speech, since the muscles of the mouth and tongue work together to form sounds.

The tongue is the primary organ involved in speech. It is also the primary organ of taste, chewing and swallowing. In chewing, the tongue holds the food against the teeth; in swallowing, it moves the food back into the pharynx, and then into the esophagus when the pressure of the tongue closes the opening of the trachea, or windpipe. It also acts, together with the lips, teeth, and hard palate, to form word sounds. Early intervention in this area is vital to a child’s development.

What to Expect From Your Child’s Therapy/Therapist

Communication-Your child’s physical or speech therapist should be communicating openly with you as to what they are doing, what muscles they are working with and why they are taking the approach they have chosen. In the case of oral motor and swallowing skills, your child’s therapist should take every precaution to minimize the risk of choking and aspirating.

You should also expect the therapist to communicate with your child. Most young children are anxious and fearful with strangers. The therapist should be working and communicating with your child to win your child’s trust and confidence. Regardless of whether your child is capable of comprehension or capable of communication, the therapist should be treating your child with respect, patience and compassion. If you meet a therapist that treats your child like an OBJECT and not a human being, FIND ANOTHER THERAPIST!

Teaching-Your child’s therapist is not only working with your child, but should also be teaching you so that you can be consistent in your child’s care and contribute to help your child achieve and maintain goals.

Questions to Ask:

  • Communication works both ways. You should be communicating any concerns and questions you have to the therapist. If necessary, keep a journal and note problems and challenges you see your child may be experiencing between therapy sessions.
  • Ask the therapist what you can do between therapy sessions to help your child maintain their progress.
  • Ask how often you should work with your child and the duration of each session.
  • If your child has been prescribed adaptive or augmentive equipment, inquire as to how often you should use the equipment and the duration of each session.

Compassion and Patience-You have the right to expect compassion and patience from your child’s therapist. If you feel a therapist is being overly aggressive and seems to be traumatizing your child… STOP THEM. Effective therapy should not be traumatizing. This is contradictive and will result in your child relating therapy to pain.

Accountability-Your child’s therapist should have written goals. You should be provided with the results of the first assessment and goals the therapist hopes to achieve in addressing issues and challenges your child may be experiencing. The therapist should do periodic assessments and provide you with goals for improvement and notify you of progress or regression on a regular basis.

Coordination-You have the right to expect your child’s therapist to work with your child’s educators in developing your child’s Individual Education Program (IEP) and to be an active member of your child’s IEP team. In the case of a private physical therapist not associated with your child’s school, he or she should be communicating with your child’s teachers and involved in the IEP process to make sure everyone is working toward the same goals.

The therapist should also be coordinating and communicating with your primary care doctor about any needed adaptive equipment or communication devices, and should keep the doctor informed of your child’s progress or problems. If the therapist feels your child would benefit from a specific communication device or piece of adaptive equipment, it is their responsibility to communicate the need to the physician and to follow-up in obtaining the device.

Continuity of Care-You have the right to demand continuity of care for your child. This means that the same therapist works with and follows your child throughout the therapy process. Of course, this isn’t always possible, but it should be the goal of any agency you work for. If your therapist belongs to a group or agency and they are sending a different therapist with each session, find another agency. This is not acceptable.

 

References

NINDS Asphasia

National Speech/Language Therapy Center

Kids Health Speech Therapy

 

FREE MEDICAL AND LEGAL RESOURCES

The Cerebral Palsy Survival Guide is a free, state-specific resource list for everything from everyday activities to emergency situations.

BI-WEEKLY E-NEWSLETTER SIGN-UP

Sign up for our e-newsletter to receive the latest in CP news, resources and

LATEST BLOG POSTS

US Health Agencies Announce Strategic Plan for Cerebral Palsy Research

Via: Cerebral Palsy News Today By: Alice Melao The 2017 Strategic Plan for Cerebral Palsy Research is finished and was recently announced by the National Institute of Neurological Disorders and…

Read more

3-D Printed Models Help Shorten Surgery Time for Common Hip Disorder in Children

Via: News-Medical.net A team of engineers and pediatric orthopedic surgeons are using 3D printing to help train surgeons and shorten surgeries for the most common hip disorder found in children…

Read more