Physical Impairment

Introduction

Cerebral Palsy

Cerebral palsy is the generic name for a group of disorders affecting muscles and movement. If, for any reason, the movement part of the brain is injured or fails to develop normally, the child may be born with or develop cerebral palsy. Approximately two people in every 1,000 have cerebral palsy. It neither worsens nor ameliorates, but stays at the same level throughout life. However, children can be taught strategies to deal with it and to develop as much independence as possible.

In cerebral palsy, messages between the brain and the muscles are jumbled. There are three types of cerebral palsy, defined by which messages are affected. Many people with cerebral palsy have a combination of these three different types:

• Spastic cerebral palsy - results in stiffening of the muscles and difficulty with joint movements. Even the simplest activities may be very difficult to do. If one side of the body is affected this is called hemiplegia. If the legs are the most affected it is called diplegia and if both arms and legs are affected it is called quadriplegia.

• Athetoid cerebral palsy - results in involuntary movements as muscles tense and relax. Often there is difficulty controlling movements for breathing and speech. Hearing may also be affected.

• Ataxic cerebral palsy - results in the whole body being affected. The individual will probably be able to walk, but their balance and coordination will be affected. They will have jerky hand movements and speech.

An important fact to remember is that no two individuals with cerebral palsy are the same. Some are affected so mildly it's hardly noticeable at first, while in others the effects are immediately obvious.

Cystic Fibrosis

Cystic fibrosis is a genetic disease that affects a number of organs in the body (especially the lungs and pancreas) by clogging them with thick, sticky mucus. This also affects the child's digestion. It is the UK's most common life-threatening childhood disease. Until the 1930s, babies born with cystic fibrosis rarely lived to be more than a few months old. Now, average life-expectancy is about 31 years and rising. Most children with cystic fibrosis can expect to reach adulthood and enjoy active and fulfilling lives. Pupils with cystic fibrosis are academically as able as their peers, but hospitalisations and chest infections can result in frequent or prolonged absences from school.

Children with cystic fibrosis may be small and underweight for their age. A daily routine of physiotherapy and exercise is essential for every sufferer, to prevent irreparable lung damage. This can be very time-consuming and frustrating. Some pupils will also be embarrassed by having such arrangements made for them. Most of those with cystic fibrosis will need to take medication (enzymes in the form of pills or powders) at meal times.

Some cystic fibrosis sufferers may also develop diabetes, for which it may be necessary to take insulin and moderate their diet. These pupils may need to use the toilet more often.

Spina Bifida

Spina bifida is one of the most common congenital disabilities, affecting approximately one in 500 births. Improved treatment since the 1980s has meant that more children with spina bifida are surviving. These children are often of average intelligence and need to be able to attend a mainstream school.

Spina bifida is an abnormality of the spinal cord where one or two of the vertebrae do not form properly, thus causing a split, which in turn causes damage to the central nervous system. Most children with spina bifida will need to be in a wheelchair and may need a specially adapted toilet seat or other adaptations.

About eight per cent of babies born with spina bifida also have hydrocephalus (an accumulation of cerebro-spinal fluid). As with other complex conditions, there are various degrees of severity and there are several different types. Spina bifida occulta is a very mild form.