Communication

Communication is necessary to express thoughts, feelings and needs. Every individual with CP needs a method of communication. It is essential for independent living and community integration. If the child can produce comprehensible sounds and syllables by 2 years of age, he will probably have normal verbal communication. Alternative communication methods using simple communication boards or high technology equipment such as computers are used in children who have difficulty speaking.

Activities of daily living

Activities of daily living are self-care activities such as feeding, toileting, bathing, dressing, and grooming in addition to meal preparation and household maintenance. Dyskinetic and total body involved children have problems of dexterity and fine motor control that prevent independence in activities of daily living. Hemiplegic and diplegic children can become functional in these areas [D]. They sometimes need help of occupational
therapy. Family attitude is a critical factor determining the level of independence of a child. Overprotection results in a shy and passive individual who has not gained self-care abilities.

Mobility

Mobilization is crucial for the young child to improve his mental capacity and understanding of the environment. Use wheelchairs or other mechanical assistive devices to promote independent mobility in the community if the child cannot achieve mobility by walking. Mobility is important to function in the fast paced societies we live in. People who have difficulty moving are always at a disadvantage. In the adult, becoming an independent member of the society and earning a living depend upon independent mobility.

Ambulation

Families view ambulation as the most important issue during childhood. This changes in adolescence. The adolescent needs education, independence, and an active social life. For him, although still important, ambulation is the least needed function. Learning how to use the computer may benefit the child more in the long run than being able to take a few assisted steps. Mobility is critical to the child, and social identity and independence are more valuable to the adolescent. Every effort must be made to increase the child’s ability to walk; however, walking depends on
the extent of the child’s neurological impairment rather than the amount of physical therapy, surgery or bracing he receives. The child achieves his or her maximum potential with practice.

Psychosocial issues

Children who receive intensive, well meaning but scientifically unproven therapies and surgery have psychological problems in adolescence and adulthood. Lack of independent mobility and presence of deformities in spite of prolonged years of therapy frustrates the adolescent who becomes aware of the difference between him and his peers as he grows older [D]. The child with CP grows up to become the adult with CP. He has to continue life
as a disabled person facing physical as well as spiritual barriers of the society. Sometimes he is forced into tasks which his functional capacity will not allow and at other times he is barred from social life. Both these result in increased frustration, anxiety neurosis or depression which decrease independence further. Keep all these problems in mind while formulating a treatment plan to address the individual’s needs.