IN-DEPTH TEACHER RESEARCH 1

In-Depth Teacher Research: Understanding the Needs and Assets of Students with Special

Needs Cerebral Palsy

Karly Colenzo

Teaching Credential Program Vanguard University

EDUG-524-01: Foundations of Teaching

Jeff Hittenberger, Ph.D

October 20, 2022

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Introduction
Cerebral Palsy is a broad spectrum of disabilities that affect an individual's ability to

move. There is a broad spectrum of diagnoses and each case varies. In some people the cause of

CP is unknown but the most common factors are prematurity, viruses, substance abuse, or injury

during pregnancy. Genetic disposition has been known to be a factor as well. Although scientists

have not found a gene that causes CP, there are genes that pose risk factors for injury.

Sometimes, CP is possible with certain conditions such as blood thinning or heart disorders.

These factors cause injury to the brain impacting movement signals to the muscles. Different

parts of the brain can be affected which is why CP can vary. According to Prue Golland, a Senior

Physiotherapist with Cerebral Palsy Alliance, diagnoses can happen at any time during a lifespan

but the average age is around eighteen months (cerebralpalsy.org 2014). What can be some

indicators of CP in babies are not being able to hold their head, feeling floppy when picked up, or

feeling stiff. At older age signs can be experiencing delayed milestones or sometimes none at all.

Certain milestones can include sitting, rolling, crawling, walking, and talking.

Although cerebral palsy is seen as one condition it is an umbrella term for more specific

areas of the body. These terms are quadriplegia, diplegia, and hemiplegia. Quadriplegia affects all

four limbs both arms and legs. Diplegia affects two limbs, the lower half of the body or legs.

Hemiplegia where one arm and leg are affected. Another way of grouping CP is the way it affects

movements through parts of the brain. The Cerebral Palsy Alliance database claims the most

common form is Spastic, with around 86% having this movement type(cerebralpalsy.org 2014).

What this entails is the muscles being tightened or stiff making it difficult to move. Again the
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severity can vary among individuals. Another category that can be identified for CP individuals is

Dystonia. This is the involuntary movement of the muscles including twisting or repetitive

movements. It can occur when an individual has intense emotions, is tired, or tries to voluntarily

move. Involuntary movements can happen throughout the whole body or in one specific part of

the body. The least common form is Ataxia which is constant shaking movements that affect

space and balance. Motor movements from this type of category are not smooth because of the

lack of balance and coordination. Any of these can both overlap in function and be prevalent in

motor skills.

In order to properly treat CP one needs to be classified in their respective classification

system according to motor skills. This is due to the wide variety of CP cases and their severity.

One classification is GMFCS or gross motor function classification system. It tests whether a

child will be able to walk independently or need assistance. The person will fall into one of the

five categories. MACS or manual ability classification system is the next classification where it

identifies if a child can properly use their hands. Another classification is the CFCS, a

communication functional classification system. CFCS tests the communication of CP

individuals with others.

Knowing the type of CP a child has will determine the type of treatment necessary for

them pharmacological and non. All of the following treatments are according to the National

Library of Medicine, Cerebral palsy in children: a clinical overview, by Dr. Dilip R. Patel.

.Someone with Spastic CP can receive pharmacological treatment such as intramuscular

injections including Phenol intramuscular, Botulinum toxin, Baclofen an intrathecal pump to

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name a few. On the non pharmaceutical side, treatments include physiotherapy, occupational

therapy, adaptive equipment, and surgeries including Selective dorsal rhizotomy.

What is important when learning about Cerebral Palsy is how many individuals are

affected by it. According to the CDC, “Cerebral Palsy is one of the most common motor

disabilities in childhood,”(Accardo, MD 2008). ADDM states, “ Around 764,000 people in the

U.S. (including children and adults) have at least one symptom of cerebral palsy,’ and “Around

10,000 babies are born each year with cerebral palsy,”(Accardo, MD 2008). This disability is

very prevalent today and continues to incline.With the rise in CP, there are laws and regulations

to make sure students with CP are supported properly in the education system. This is a

possibility through the ADA or Americans with Disabilities Act. In Title 42 of the ADA, it states,

“Physical or mental disabilities in no way diminish a person's right to fully participate in all

aspects of society, yet many people with physical or mental disabilities have been precluded from

doing so because of discrimination; others who have a record of a disability or are regarded as

having a disability also have been subjected to discrimination,” (ADA 2008). Another law put

into place was, “Section 504 of the Rehabilitation Act passed in 1973 prohibited recipients of

federal financial assistance including schools from excluding individuals from participation in

any program or activity on the basis of a handicap” (Rothstein, 2000). These laws provid the

structure for CP individuals to receive the proper education.

History

Cerebral Palsy has come a long way in terms of awareness and advocacy. It has been a

disability that has been recorded throughout time. In Hallmarks in the history of cerebral palsy,

author Christos Panteliadis writes, “The first conceptions of cerebral palsy and our knowledge
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about etiology and pathology allow us to assume that cerebral palsy existed in the Ancient

World. Although there is a lack of detailed medical descriptions from before the 19th

century..cerebral palsy can be found in representational art, literary sources, and

paleopathology,”(Panteliadis 2013). There is a lack of documentation about CP that leaves gaps

in its history. Only accounts of CP fall within one Greek Physician before the 19th century, “In

the Ancient World, the first medical description of cerebral palsy was made by Hippocrates in his

work ‘Corpus Hippocraticum,’”(Panteliadis 2013). Others would follow after into actively

engaging in CP, “Little was the first personality to intensely engage cerebral palsy towards the

end of the 19th century, two more personalities emerged, adding to the historical hallmarks of

cerebral palsy: William Osler and Sigmund Freud,”(Panteliadis 2013). At that time these were

the only three personnel to truly study this scope.

As awareness came about there was a need to provide care. The first known care was

nowhere near acceptable “State institutions were intended to protect society from the individual

rather than to provide appropriate care of individuals, based on their physical, health, and specific

educational needs…Institutions were often overcrowded, short of necessary resources, and

lacked any type of programs that focused on education,”(Fulk 2011). Luckily there were many

resources for people with CP after ADA came into play. UCPA was created after WW2 as an

advocate group. Also, literature was being written to learn, treat, and diagnose CP, “ For specific

information on obscure, rare disorders, it was necessary for teachers and school psychologists to

consult the latest edition of the Merck Manual of Diagnosis and Therapy, 13th Edition (1977), a

commonplace tool of physicians that was used as a disease-oriented listing of etiology, symptoms

and signs, diagnosis, and treatment options,”(Fulk 2011). As more students with disabilities came

into the school systems there were more adaptations. For example, schools implemented a share
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and exchange with parents. Essentially this created a connection between parents and schools to

help physically disabled children be more supporters. There are also organizations today such as

TASH it’s, “An international advocacy organization focusing on equity issues, more

opportunities for people with disabilities, and inclusion in schools and communities,”(Fulk

2011). The most recent effort towards PD today is the Individuals with Disabilities Education

Improvement Act or IDEIA. It states that it, “Helps to ensure equity, accountability, and

excellence in education for children with disabilities,” (frcnca 2020).

Case Study

Although cerebral palsy presents as brain damage it does not stop those with the

disability from being cognitively intelligent. A case study at Pennsylvania State University was

done on two individuals who were inaudible living with CP. Their premise was around the idea

that cognitively gifted CP individuals would intellectually be under-stimulated because of the

grouping of their disability. The purpose of the study was to understand how people with CP

demonstrate their intellectual ability. Also to understand what strategies help them best when

growing intellectually.

The study design was a qualitative study created by Willard-Holt. His questions that

created this design were, “: In what ways do gifted children who have cerebral palsy and do not

speak indicate their cognitive abilities? What teacher behaviors and instructional techniques are

effective in developing their cognitive abilities?”(Holt 1994).

A multiple case study was used for, “ Comparisons of indicators of cognitive ability and

the effects of classroom experiences across different educational, therapeutic, and home

contexts,”(Holt 1994). Ethnographic methods included observations from audiotapes, videotapes,

and documents.
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Holt for his subject had two individuals with CP who were nonverbal. The first

participant was studied from first to second grade; Jan had athetoid and spastic cerebral palsy,

affecting voluntary muscle movement throughout his body. His communication was through

body motion and by spelling on an alphabet board. Regardless of his lack of speech he had a rich

vocabulary and loved poetry. Hoit's second study participant was a 14-year-old boy, Brad,

starting his freshman year at high school with athetoid and spastic cerebral palsy. Brad was a

well-rounded child who excelled in both school and extracurriculars. He was enrolled in college

preparatory classes and had been on the honor roll every semester except one. Also outside of

academics, he was on the student council and basketball manager of the school's team. The

source of communication for Brad is by eye-pointing at an alphabet board, and keying Morse

code into a computer.

Results of the study expression of cognitive abilities and effects of classroom experiences

on intellectual development. Both participants were well beyond gifted in their cognitive

abilities. This was at first unrecognizable due to the lack of communication that fit their needs.

The two participants could read at an early age but their parents could not assume so until they

were able to communicate properly. Brad would go through rigorous coursework passing with

better grades than his peers. Jan, although given accommodations to go at his own pace, would

finish before other students could. They also had a good sense of humor whether they would read

or write it. Another notable insight was their maturity. Many of their traits included motivation,

persistence, determination, patience, and goal orientation. A lot of the traits were not noticeable

to teachers because they were in social interactions.

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The next results revolved around how classroom experiences affected intellectual

interaction. The premise was around, “Classroom atmosphere, structures, and instructional

activities differentially impact the intellectual development of gifted students physically,” ”(Holt

1994). Holt observed that having a relaxed and positive attitude where students feel respected

helps in a better classroom environment. Students with CP felt the ability to take risks but still

feel a sense of belonging and value during failure. Jane's work focused on individualization and

achievement based. This specific method worked best because he was able to work quickly

mentally but adaptable physically. Also, “ Simulations and thematic units were effective in

tapping Jan's storehouse of information and in building broader understandings,”(Holt 1994). As

for Brad, he was able to individually choose the coursework that met his needs. Brad learned

best from lectures but it was difficult for him to participate. Reading was an activity that was hard

for him because it was difficult to focus. Both classrooms in Jan's and Brad's case tried to actively

engage them in conversation. Teachers created a space filled with patience in their responses.

Classroom Modifications/Accommodations:

Cerebral Palsy is such a broad umbrella term for people with this disability. When it

comes to modifications and accommodations there is no definitive answer. The first step that

must be taken would be to understand what type of CP a student has. Following that would be

listening to how your student wants to be accommodated. This is one of the most important

aspects when understanding accommodations. When interviewing one of my close friends

Wendy who has CP, gave a good insight on this concept. She states that some teachers would

automatically sit her in the back to accommodate her CP. She said, “ I really valued my learning

and would want to sit in front of the class to be more involved. It helped me to focus and engage
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in the material,” (personal communication, October 20, 2022). Teachers would automatically

place her in the back of the room not knowing her preference is to be in the front. Another

notable aspect of accommodations is knowing how to speak to a student, not their disability.

Wendy said that the best teachers she had pushed her to be better despite her disability. In the

same instance, she had teachers that would not push her and it was discouraging. In one instance

Wendy said, “ A teacher knew I was struggling to walk and automatically thought I needed a

wheelchair. It was discouraging because it made me feel that my teacher didn't believe in me to at

least walk,” (personal communication, October 20, 2022). It’s important in this instance to

always encourage and not demote. To let students communicate their needs rather than us trying

to overcompensate for their disability.

There are many tools that come into play when dealing with CP students. Some of these

devices include physical and visual massive modifications. Adaptive equipment is used to help

with mobility and motor control. These items include walkers, braces (AFOS), orthotic boots,

stool scooters, and standing equipment. All of these fall into the mobility category and are

needed every day for a person with CP. Another physical modification with activity includes

adaptive supplies. A student with CP can struggle with fine motor skills and teachers need to be

able to accommodate this by having proper supplies. Supplies include specialized scissors, pencil

grips, and palm weights. Visual assistive tools deal with students who are nonverbal or

paraplegic. These tools include electronic communication boards, speech-generating devices, and

eye-tracking devices. All of which are used to communicate with CP students.

Setting up my PE class to fit a person with CP would have to be a place for efficient

adaptations. Keeping in mind that CP is different in every case these would be my general

modifications. First I would have to know my activity for the day and preplan the adaptation for
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that student. Then go along with the lesson plan for the day and see if I have the materials in the

PE class to modify. One thing I would be mindful of is accessibility to outdoor and indoor

activities. Questions I would ask are: could my student efficiently move on the surface and if not

how do we modify it? Also, I would try to incorporate motor skills that students need to improve

on in order to build muscle hypertrophy. Depending on the severity of CP a student could have an

aid that assists with adaptive activity. Overall I think PE is one of the most important classes for

students with CP. It gives them a chance to work on motor skills and motor learning. So it is

essential to give students the accommodations and modifications they need.

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Citations

Ackroyd, P. R., Evans, C. F., Lampe, G. W. H., & Greenslade, S. L. (1963). The Cambridge

History of the Bible. Amazon. Retrieved October 28, 2022, from

https://www.amazon.com/History-Special-Education-Advances/dp/0857246291

ada.gov. Americans with disabilities act of 1990, as amended. (n.d.). Retrieved October 28,

2022, from https://www.ada.gov/pubs/ada.htm

Centers for Disease Control and Prevention. (2022, May 2). Data and statistics for

Cerebral Palsy. Centers for Disease Control and Prevention. Retrieved October 28, 2022,

from https://www.cdc.gov/ncbddd/cp/data.html

Cerebral palsy diagnosis. cerebral palsy.org. (n.d.). Retrieved October 20, 2022, from

https://www.cerebralpalsy.org/about-cerebral-palsy/diagnosis

Panteliadis, C., Panteliadis, P., & Vassilyadi, F. (2012, June 2). Hallmarks in the history of

cerebral palsy: From antiquity to the mid-20th century. Brain and Development. Retrieved

October 28, 2022, from

https://www.sciencedirect.com/science/article/abs/pii/S0387760412001179

Patel, D. R., Neelakantan, M., Pandher, K., & Merrick, J. (2020, February). Cerebral palsy

in children: A clinical overview. Translational pediatrics. Retrieved October 28, 2022, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082248/

Sussman, M. D. (2010). Book review: J. R. Gage, M. H. Schwartz, S. E. Koop, T. F.

Novacheck (eds): The identification and treatment of gait problems in Cerebral Palsy.
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Journal of Children's Orthopaedics, 4(2), 177–178.

https://doi.org/10.1007/s11832-010-0244-z

Two case studies. (2016). Supporting Children with Cerebral Palsy, 25–26.

https://doi.org/10.4324/9781315643168-12

Willard-Holt, C. (1998). Academic and personality characteristics of gifted students with

cerebral palsy: A multiple case study. Exceptional Children, 65(1), 37–50.

https://doi.org/10.1177/001440299806500103