What we Know About Pain in Children with Cerebral Palsy

Gianna is a 4-year old girl with bilateral cerebral palsy, GMFMCS level IV.  She has mixed tone with components of both spasticity and dystonia.  Over the last month she has been acting differently, with loud vocalizations, irritability, agitation, increased muscle tone, sleeplessness, and episodes of teeth grinding.  Everyone in her family has been feeling heightened stress.  Is Gianna in pain?  She can’t clearly relay what she is feeling and where it hurts because she is non-verbal.  There is no obvious swelling or redness on any area of her body.  As her PT, how can you tell if she is experiencing pain?

Gianna’s situation is common. The SPARCLE study in Europe identified that children with CP experience more pain than their peers and that pain can lead to a lower quality of life, decreased participation, and family stress.  Pain has been found to decrease quality of life more than the physical disability itself.  As a health practitioner, it can be difficult to determine the presence of pain unless there is a visible sign, localized pain, or the child can verbalize what they are feeling. Continue reading “What we Know About Pain in Children with Cerebral Palsy”

Using Core Sets With the International Classification of Functioning-Children & Youth (ICF-CY)

Emil is a seven-year-old  boy with cerebral palsy and medical complexity.  He has lived in a rural region overseas until coming to see you for a physical therapy evaluation.  Thinking of Emil functioning, in the context of his life, what areas should you focus on?  When thinking about the whole child, physical therapy decision-making can become a bit overwhelming.  Is there a list that can help you concentrate on the most relevant areas of body structures/function, activity, and participation for a seven-year-old boy with CP?

I am reading an interesting book that discusses the power of checklists.  It’s called the Checklist Manifesto: How to Get Things Right and it is written by Atul Gawande.  In this he discusses how checklists are most effectively used to assist people as they deal with complex situations.  After reading this, I began to view the ICF core-sets as essential checklists to reduce error and foster team communication. Continue reading “Using Core Sets With the International Classification of Functioning-Children & Youth (ICF-CY)”

Are You Helping a Child Move Before They are Ready? Thinking About Latency in the Context of Movement.

“Nate,   stand up”.  Nathan is five, has cerebral palsy and takes a while to prepare to move his body.  Thirty seconds or more can pass between the request to move and getting a response.  He is quiet, then there may be a quiver of movement. Sure enough, after some patience, up comes the leg and he rises to standing with only a little assistance.  In the context of the classroom, this extra waiting time is surely difficult.  Nathan either arrives late to an activity or his aide is lifting and initiating for him throughout the day and a behavioral expectation is set up.

Children with motor planning difficulty need extra time to initiate and carry out their movement.  Many of us live in a world where time is scarce and we don’t feel that we have time to wait. On the other hand, starting with the end in mind is crucial and takes a lot of training, repetition and patience.  What have you decided to do when faced with this dilemma?

Continue reading “Are You Helping a Child Move Before They are Ready? Thinking About Latency in the Context of Movement.”