Hesperian Health Guides
Developing Early Skills
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Most children with cerebral palsy develop basic skills and abilities more slowly than other children. This is partly because of their difficulty with balance and movement. Also, in some children, mental slowness or problems with seeing or hearing make learning more difficult. Because slow development occurs with many different disabilities, we discuss activities for child development in a separate section of this book.
In this chapter, therefore, we give only a few suggestions for assisting a child with cerebral palsy to learn new skills.
Although Chapters 34 to 41 are written to help any children who are slow to develop, many suggestions are included for the specific needs of the child with cerebral palsy.
To help a child develop new skills, first observe all the things that she can and cannot do. Like a normal baby who progresses stage by stage in a certain order, the child with cerebral palsy must do the same. See charts showing the normal ‘developmental milestones’. You can use them to help decide the next steps or skills that the child may be ready to learn.
Help the child advance slowly, at her own speed, in small steps. If we try to go too fast because of her age, she can become discouraged by failure. Also, her progress can be held back. This happens when we stand a child and try to make him walk before he is ready. (See "Normal Child Development")
Move ahead at a speed that fits your child— not too fast and not too slow.
To help a child with cerebral palsy develop skills takes a lot of time, energy, patience, and love. The whole family needs to help, and also, if possible, others in the community. (See Chapter 33.)
Remember that positioning is very important. When the child has been helped to lie, sit, and stand in ways that give him better positions and control, he will start learning to do things he could not do before.
Good balance is one of the most important goals for the development of the child with cerebral palsy. It is important to help a child improve her balance from as young an age as possible. At each stage of the child’s development—lying, sitting, creeping, standing, and walking—better balance is needed to progress to the next stage.
Helping improve balance
Detailed suggestions of activities to improve balance are included in Chapter 35, “Early Stimulation Activities,” especially "Activities for Body Control, Balance, and Sitting" to 312. Here we give you a brief look at some of the basic suggestions explained in more detail in that chapter.
|POOR BALANCE||BETTER BALANCE||GOOD BALANCE|
|If when you sit a child over 10 months old, she falls stiffly to one side with no effort to ‘catch’ herself, her balance is poor.||If she can balance using her arms when you gently push her, her balance is fair.||If she can do it by bending her body, without using her arms, her balance is good.|
Encourage the child to shift weight from one arm to the other by reaching for objects,
|reaching forward,||and reaching sideways.||Lay him on your body and tip a little from side to side so that he begins to catch himself.|
Whenever possible, turn these activities into games. Talk to the child a lot while you do them to help develop language skills at the same time.
|Let her start to fall so that she begins to catch herself.||Sit her across your knees. Raise one knee so she has to balance.|
|As the child improves, use a tilting board.||Encourage the child to twist and reach to the side.||Use as little sitting support as needed. Often low back support is enough for a child who straightens stiffly.|
For creeping and crawling
Note: Some children advance to standing without ever crawling.
|Shift weight from one arm to the other. Provide support as needed, and gradually take it away.||Shift weight from one leg to the other.|
|Play trying to balance on a tipping surface.||Crawl forward, sideways, and backward.||crawling scooter|
For standing and walking
|Stand and balance on knees.||Pull to stand.||Stand while holding on, and reaching.|
|CAUTION: Not for a child with bent-knee spasticity.||(Often the child will stand better when he pulls himself up than when someone helps him.)|
|Help with standing and then walking.||Give less and less support while he walks with only a ‘safety-belt’—and then alone.||Have the child practice stepping forward, backward, and sideways.|
Skills for daily living and self care
A child with cerebral palsy will get abilities later than other children—but she will get them! Of course, the child may not achieve everything, and may not always walk. But make sure the child achieves what she can in each important area of development:
Now point to the rabbit.
That's right! Good girl!
The child will often need a lot of help with language and communication skills. Develop these skills in whatever way seems possible: using words, gestures, pointing (with hand, foot, head, or eyes), or with communication boards. (See Chapter 31 and "Communication Aids".)
Help the child become as independent as possible in eating, dressing, washing, toileting, and in meeting other daily needs. Do this by guided practice, imitation, and step-by-step learning. These self-care skills are discussed in Chapters 36 to 39.
|Keep experimenting until you find what works best.|
|For example, this girl, with poor body and hip control, tends to fall through the space between her arms when the handgrips on the walker are upright.||She does much better on a higher walker with a handgrip that runs from one side to the other.|
Often leg braces do not help a child with cerebral palsy walk better. But sometimes they do. When in doubt, try low-cost braces first, to look for possible problems. For example:
|Carla walks in a very crouched position.||She may be helped by below-knee braces that hold her feet at nearly a right angle (90°)||or by above-knee braces that keep her knees almost straight...||But it is possible that the below-knee braces will throw her badly off balance,|
|and that the above-knee braces will make balancing even harder.|
You will need to experiment!
|Even if braces for walking do not work, Carla may be helped to walk straighter by using ‘night splints’ to hold her knees straight and prevent contractures.|
IMPORTANT! Practice in learning skills should take place with family and friends so that the child develops skills in relating to others. However, the child will also need time to practice her skills alone and with the personwho is mainly responsible for treating or teaching her.