What is cerebral palsy (CP)
Cerebral palsy is a group of disorders that affects a child’s not only movements and co-ordination but also sensory skills and cognitive functioning. CP children display features of sensory integration disorders or sensory difficulties or abnormal type of sensory processing.CP children with sensory integration difficulties may have problem in auditory, olfactory, gustatory, proprioception, tactile, vestibular and visual impairment. It can be over sensitivity or under sensitivity. As a result, a child may face difficulties in activities of daily livings such as brushing, feeding, combing, dressing etc. Some children have problem in social skills, which lead to difficulties in schooling and play activities.
Challenges CP children may face
The tactile system receives the sensations of pressure, temperature, and pain through in the skin, mouth, throat, ear etc. Tactile hypo or hyper responsiveness child under response or over response to touch. Sometimes referred to as being “tactually defensive”. They do not like being in groups, being physically close to others. They may withdraw socially, even finding parental hugs to be uncomfortable. Sometimes they may have difficulty in discriminating between different types of tactile input. They may even have difficulty registering pain and pressure. Tactile deficit on finger or hands causes fine motor skills problem. Therefore, child faced problem in holding pencil, which lead to delay in writing ability. They may also face problem in eating, buttoning and tie shoe. Tactile defensiveness under foot causes problem in walking, running and jumping.
The vestibular system senses responsible for movement of the body, balance, and vibration. This system helps us to know our bodies are moving, the direction of travel, and the speed. We use this system to walk around, run, and ride bus or bicycle etc. A child with vestibular dysfunction might be able to spin excessively without becoming dizzy, or may move constantly. On the other hand some child might resist moving. Vestibular hypo/hyper responsiveness can make child in walking disturbances and gravitational insecurity. For example: A Diaplegic type of cerebral palsy child has full muscle strength but he/she faced difficulties in walking due to gravitational insecurity.
Auditory hypo/hyper responsiveness child can’t process what they hear because of their ears and brain doesn’t fully coordinate. Something interferes with the way the brain recognizes and interprets sounds, especially speech. These types of child have speech and language delays or problems learning in school. The problem is that they usually do not recognize differences between sounds in words, even when the sounds are loud and clear enough to be heard.
These problems usually happen when there is background noise, which is often the case in social situations. So child auditory processing disorder have trouble understanding what is saying to them when they are in noisy places like a playground, sports events, the school cafeteria, and parties.
Visual Perceptual difficulties child with cerebral palsy has difficulty in walking downstairs. Child may have difficulties seeing things which are moving quickly, difficulty in copying words or drawing. Sometimes child cannot understand distance or depth of space due to visual hypo responsiveness/hyper responsiveness. They also have problem to identify colour, shape etc. They faced problem in reading and writing.
The proprioceptive system provides feedback as to where specific body parts are placed, muscles and joints. Well-functioning proprioceptive systems give us a sense of where the body is placed in space. For example, proprioceptive system gives us feedback that our feet are flat on the floor and we able to remain stable, even without thinking about it. Child with proprioceptive difficulties have problem in body awareness, safety issues and postural control.
Olfactory system gives us smell sense. Sometimes child with smell problem may be enjoyed or avoid. Some child may be avoiding gas fumes, spoiled milk, etc. The child with olfactory dysfunction may avoid people, object, food or places etc. Sometimes they dislike perfumes.
The sense of taste is closely connected to smell. Child with taste issues may dislike or prefer certain textures, temperatures, or levels of spiciness (outside of family food preparation practices). The result is that they reject many food enjoyed by others.
Some children have a mixture of the two sensitivities, being hypersensitive to one type of touch while being hyposensitive to another type of touch. Some children’s sensitivities also change from day to day and situation to situation.
Child feeding issues are also related with sensory integration. Nutrition of a child is very important for physical and mental development. However, some cerebral palsy child faced difficulties to feeding issues. Because they cannot feel or realize the sense of food. Oral motor sensory problem causes gagging, vomiting, lack of interest to take food. It can causes problem in chewing, swallowing and sucking issues. The orally defensive child often has a limited choice of foods he/she may eat only mushy foods, only crunchy foods or only bland foods, etc. Some avoid foods of a certain colour. They may avoid using their lips or use teeth only. Some may be overly sensitive to brushing their teeth or being touched around the face and lips.
Sensory processing disorders can causes a big problem in our daily livings. Sensory processing can affect a child’s classroom performance. They cannot make peer group. It can hamper the development of positive self-esteem, interacts in the world. Mainly children with cerebral palsy have sometimes increased or decreased ability to process sensory. Sensory integration therapy helps to build the mental or physical framework within individual’s nervous system to properly perceive sensory input, regulate response understanding the significance behind a particular, texture, movement or sound. The benefits of sensory integration therapy are often physical but also social and psychological. Occupational therapist uses sensory integration approach to treat a child with cerebral palsy. Occupational therapists assess the child and according to needs prescribed Sensory diet/lifestyle.
In our country many children with sensory integration dysfunction and their parents are suffering with these types of problems. They face challenges in development, learning, playing, socialising and appropriate behaviour. Occupational therapy intervention can play vital role for child with sensory processing disorders. Occupational therapist helps to promote, maintain and development of skills. Also helps to active participation in life promotes learning, self-esteem, self-confidence and social interaction. This is beneficial to remove child challenges to learning and become more skilled. Occupational therapy improves the ability to process sensory information so that the child will function better in his/her daily activities.
The writer is a Senior Clinical Occupational Therapist, Centre for the Rehabilitation of the Paralysed (CRP) - Mirpur, Dhaka