Feeding Children with Spastic Cerebral Palsy

In cerebral palsy there are 3 biggest problems that the spastic children are – the body is in a poor position, the jaws are tight, the tongue pushes the food forward. Swallowing is difficult because of some reasons like head pushing back, jaw and lips are not closed, the bottom lips tend to bitten in by the top set of teeth or mouth is wide open, tip of tongue is down behind the teeth, the tongue cannot roll the food back to mouth or there can be chewing problem.

There are also some problems with breast feeding or feeding by bottle. The child would push back his head and body and their legs and arms would get stiff. They cannot suck and swallow easily. So it is very important that the head and body should be in correct position, all the muscles of neck and jaw must be relaxed, jaw must be back and not clenched, the lips must be together and the tongue must be able to move the food from side to side in the mouth.

To breast feed or by a bottle a child with cerebral palsy the head must be in forward direction so that he can swallow more easily. The baby must be in half sitting position with hips bent and the mother must keep the shoulders of baby in forward direction by pushing firmly on the chest. In feeding by bottle the teat of bottle should be bigger in size so that it would not choke.

The therapist should concentrate to control jaw movement in the child. If the therapist teaches a child how to control his mouth, particularly his jaw, then sucking and swallowing, spoon feeding from plate and drinking from a cup can be improved. To teach a child the therapist should sit in a chair facing the child’s face. The therapist can put the child on his lap or on standing frame (it simultaneously relax the muscles of whole body during feeding).

The position of child should be decided according to child’s age and ability. The therapist should stabilize the head then clasp the jaw and the index finger should be kept on the jaw of the child. The therapist should push the jaw backward (not downward) and push the bottom lip up, as this is necessary for swallowing. The third finger is put under tongue, to help the tongue move. The other fingers are lifted away from the child’s face. To reduce the Plasticity the therapist should use his right index finger and introducing inside the child’s mouth he should move the finger in semicircle on the top gum from middle to left then to right side. This is done firmly and not too fast. It is done 3 times and the child is encouraged to swallow by the 3rd finger of the left hand moving from forward to backward.

The therapist must also concentrate on hand activities (prehension and precision) to teach the child to hold plates and spoons to feed themselves. While teaching therapist must work on dominant as well as non-dominant hand. The non-dominant hand should be stabilized during activities of dominant hand and vice versa.

The swallowing activities also depend on quality of food. It must be started from liquid then semisolid and finally solid. Only metal teaspoon must be used to feed a child. Small amount of food must be put on the teaspoon. The spoon must be put right in the mouth and pressed down to the tongue. By doing this the tongue will be encouraged to stop pushing the food forward and the child will be able to use his lips better. To teach drinking water or milk the therapist must correct the shape of the plastic cup.

Cut a semicircle at the mouth of one side of plastic cup so that the child will not push his head back to get the liquid. Keep the cut part upward and put the cup on top of bottom lip and then tilt the cup slowly upward. The therapist must demonstrate all activities to child’s mother so that she will learn how to feed his child.

Author Bio:

Kanhaiya Jha is working as Sr. Associate - Internet Marketing. Get in touch with him on Facebook here.

Communication Problems and Dysarthria

Dysarthria refers to speech problems. The child has difficulty producing sound and articulating words. Dysarthria occurs in 40% of patients. The causes are respiratory difficulties due to respiratory muscle involvement, phonation difficulties due to laryngeal involvement, and articulation difficulty due to oromotor dysfunction. Spasticity or athetosis of the muscles of the tongue, mouth and larynx cause dysarthria. It is important that every child is provided with an alternative means of communication as early as possible to avoid further disability.

Oromotor dysfunction

The child has difficulty sucking, swallowing, and chewing. Drooling , dysarthria and inability to eat result in failure to thrive, delayed growth and nutrition, poor hygiene and impaired socialization.

Teeth problems

Dentin : Primary or hyperbilirubinemia

Malocclusion : Spasticity

Tooth : Decay Feeding swallowing problems

Gingival : Hyperplasia Antiepileptic drug use

Gastrointestinal problems and nutrition

There is a general deficiency of growth and development. Children with dyskinesia and spastic quadriplegia fail to thrive. This is related to inadequate intake of food, recurrent vomiting with aspiration secondary to gastroesophageal reflux and pseudobulbar palsy. Difficulties in swallowing (dysphagia), hyperactive gag reflex, spasticity or loss of fine motor control impair feeding. Gastroesophageal reflux and impaired swallowing cause aspiration pneumonia. Many children with CP have high basal metabolic rates. Increase in basal metabolic rate coupled with feeding difficulties cause malnutrition. Malnutrition may be severe enough to affect brain growth and myelination in the first 3 years of life. There is immune system suppression and increased risk of infection.

Respiratory problems

Aspiration in small quantities leads to pneumonia in children who have difficulty swallowing. Premature babies have bronchopulmonary dysplasia. This leads to frequent upper respiratory tract infections. Respiratory muscle spasticity contributes to the pulmonary problems. These problems can be reduced by various chest physiotherapy.

Bladder and bowel Dysfunction

Loss of coordination of bowel and bladder sphincters results in constipation and/or incontinence. Enuresis, frequency, urgency, urinary tract infections and incontinence are common problems. The causes are poor cognition, decreased mobility, poor communication and neurogenic dysfunction. Urodynamic assessment has demonstrated bladder hyper-reflexia, detrusor sphincter dyssynergia, hypertonic bladders with incomplete leakage and periodic relaxation of the distal sphincter during filling.

Constipation is a common but overlooked phenomenon. It causes distress in the child, increases spasticity and results in poor appetite. It is a result of many factors, including poor diet and decreased mobility. Establishing a routine for bowel training and encouraging upright posture help reduce constipation.

Urinary problems may include enuresis, frequency, urgency, urinary tract infections, incontinence. Causes of urinary problems can be poor cognition, decreased mobility, decreased communication skills, Neurogenic dysfunction.

Psychosocial problems

A diagnosis of CP is extremely stressful for the family and the child when he grows up. This causes various reactions ranging from denial to anger, guilt and depression. Coping with the emotional burden of disability is easier if the family has strong relationships, financial security, and supportive members of the community. The child and the family need to find ways to connect to each other. A healthy relationship between the mother and the child forms the basis of future happiness. Prevention or appropriate treatment of associated problems improves the quality of life of the child and the family.

Author Bio:

Gajendra Jain is Sr. Software Engineer with Daffodil Software Ltd. Connect with Gajendra on Facebook here.

Group Therapy and Socialization in Cerebral Palsy Children

Group Therapy and socialization is essential in the cerebral palsy children. Group Therapy is meant by therapy done in group of same population. In this technique same cerebral palsy children were collected and given same kind of therapy. Socialization is a technique in which cerebral palsy children were exposed to entire world to get prepared for the world’s challenges.

Group Therapy increases the concentration and the competition between the children. This concentration and competition felling gives a sprit to do work. Like other children cerebral palsy children also like complements, competition. In group therapy we mostly give same task to all children and ask them to complete in ease and in less time.

For example if we ask children to pick same color ball by their right hand and to put it in a bowl kept on the opposite side. Ask this to do faster and with ease this challenge and competition produce a spit to complete the task. By Group Therapy any activity can be approached. There are many fine motor movements like griping any object by full hand, four finger and thumb, two fingers and thumb or three fingers and thumb.

Organize children according to their disability as mild moderate and severe. We have to also divide them into hypertonic and hypotonic group. Now decide the therapy which is given in which group. For example as hypertonic group we have to teach them the relaxation, so for this we lie down all of them in plinth and ask them to relax their muscles by producing a competitive environment. This can help children to get the things the things more easily. As in hypotonic children we stimulate them ask for the movement in a competitive way.

Group therapy is very effective because the environment in same group is more according to them then the real world. In the real world they feel themselves weak and differently baled  First prepare them in their own group then we can put them in social world.

Social world means the world in which we live. As human being is a social body not possible to live alone without society. Socialization is technique by which we make these children expose to the society. As because of their disabilities they were kept inside the home by their parents. This can be because of many reasons as such they pamper them a lot, they think that child may get depressed or parents thing them a curse and feel guilt of them. All this prepare a self centered world in mind of these children. They feel them alone and away from society.

Socialization is must in these children. In this technique parents having the greatest role so counseling of parents is must. Teach parents how these children can be socialized. There are main two steps of socialization, first is home and second is school.

Tell them when child is too little parents usually keep the child with them all time only. Usually mothers not allow anybody to touch their child, teach them that to recognize all the family members is important. Allow the child to roam here and there. Let the other normal child to play with them. Talk with them frequently about every subject as talk to normal child, this increase the interest and knowledge of the child.

If child can move let them out with or without parents. Introduce them with strangers. In school going age if child is able to speak, understand so admit them in a normal school. Here in normal school society makes them aware and prepare for the barriers and difficulty might come in their life ahead.

My name is Babuli Nayak and I am an internet marketer at Daffodil Software. I have a clear understanding of Organic Marketing and have 3 years experience Connect with Twitter at @ibabulinayak .