ASSOCIATED IMPAIREMENTS

AND DISABILITIES
Impairment refers to fundamental anatomical,
physiological or psychological deficits.
Disabilities refers to compromises in
functioning that a person experiences as a
consequence of an impairment.
 VISION
• 40% have abnormality of vision or
oculomotor control
• 7% have severe visual deficit
• Myopia,strabismus,visual field
defects,cortical blindness
• Retinopathy of prematurity
• (evans,elliot,alberman and
evans,1985,avery )
 HEARING
• Hearing loss 3-10% (evans et al 1985)
• Incidence probably 20-25 %( mowat,1961)
• Premature children at a higher risk than
children born at term
(thiringer,kankkuren,liden,and niklasson
1984.)
 COMMUNICATION PROBLEMS
AND DYSARTHRIA
• Dysarthria occurs in 40% of children with
C.P.
• Spasticity or athetosis of muscles of trunk
cause dysarthria
• Articulation difficulties due to oro-motor
function, phonation difficulties due to
laryngeal involvement, and respiratory
difficulties due to respiratory muscle
involvement contribute to dysarthia.
 RESPIRATORY PROBLEMS
• Aspiration in small quantities leads to
pnuemonia(those who have swallowing
difficulties)
• Premature babies have
bronchopulmonary dysplasia leads to
frequent upper respiratory tract infections
(those who have RDS
• GIT and respiratory problems coexist may
compound each other
 EPILEPTIC SEIZURES
• Seizures affect 30-50% of children with
C.P.
• Common in children with total body
involvement, hemiplegia, those who have
mental retardation, postnatally acquired
cerebral palsy.
 Cognition,mental
retardation,learning disability
• Memory,language processing,problem
solving,attention affected.
• Incidence of moderate,severe and profound
mental retardation is 30-65%.
• 255 of children with C.P have lower I.Q scores
than typically developing children or have
learning disabilities such as abnormalities of
visual perception or problem solving.cognitive
disabilities more,severe the motor impairement
(spastic quadriplegia,mixed cerebral palsy.)
 OROMOTOR DYSFUNCTION
• Sucking, swallowing, chewing
mechanisms are impaired,
• Drooling, dysarthria, and inability to eat
result in failure to thrive, delayed growth
and nutrition, poor hygiene and impaired
socialization
GASTROINTESTINAL PROBLEMS
AND NUTRITION
• Deficiency of growth and development
• Inadequate intake of food, as recurrent vomiting with
aspiration secondary to gastro-esophageal reflux and
pseudo bulbar palsy.
• Difficulties in swallowing(dysphagia), hyperactive gag
reflex,spasticity or loss of fine motor control impair
feeding.
• GER and impaired swallowing cause aspirtaion
pneumonia.
• Increase BMR with feeding difficulties cause
malnutrition.
• Colic (gir,constipation,uti,pressure ulcer,dental
problem,dislocation,lack of sleep,sleep apnea)
 SKIN BREAKDOWN AND
PRESSURE SORES
• Children with C.P vulnerable to developing
pressure sores
• Older children because of poor
mobility,poor fat stores caused by chronic
poor nutrition contribute to the
development of decubitus ulcers.(also
particulary after operative casting)
 HYDROCEPHALUS
• Pressure hydrocephalus encountered wih
increased frequency in children with C.P
especially among those born prematurely.
 BADDER AND BOWEL
PROBLEMS
• Enuresis,frequency,urgency,urinary tract
infections,incontinence common as
decreased mobility, poor cognition,poor
commmunication and neurogenic
dysfunction.
• Bladder hyperreflexia,detrusor shincter
dyssynergia,hypertonic bladders.
• Constipation,increases spasticity,poor
appetite,as poor diet decreased mobility
PSYCHOSOCIAL PROBLEMS
Diagnosis of C.P stressful for family and
child.
Coping with emotional burden of disability
Is easier if family has strong
relationships,financial security and
supportive members in the community.
Prevention or appropriate treatment of
associated problems improves the quality
of life of the child and the family.
 DENTAL PROBLEMS
• Oral hygiene affected as abnormal oro-
motor reflexes, bite reflex+, tongue thrust+
• Dentin primary or due to
hyperbilirubenimia
• Malocclusion spasticity
• Tooth decay feeding, swallowing
problems
• Gingival hyperplasia antiepileptic drug
use.
 OTHER SENSORY
IMPAIREMENTS
• Besides hearing and
vision,somatosensory deficits present
• Abnormalities of proprioception, and
awareness of limbs in space
• Molnar,1992.