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The influence of a lifespan approach to persons with Cerebral Palsy : an opinion paper

Clinicians who use a lifespan approach to the management and treatment of persons with Cerebral Palsy recognize that persons with this disorder may progressively deteriorate over time. The lifespan approach encourages documentation of problems that are evident in adulthood so clinicians may begin to understand and develop strategies for prevention. Specific knowledge of impairments and disabilities which negatively impact the transition of an infant to a preschooler to a school age child to an adolescent to an adult, will influence the focus of treatment interventions over the entire lifespan. A person's disability level could be classified to develop a knowledge base of long term development in persons with cerebral palsy. There are several different mortality rates based on disability People who are severely impaired have a shorter lifespan, but less is known about morbidity as these people may be unable to communicate effectively. Infants and children with more severe impairments are those who are unable to move or feed themselves and will be considered Gross Motor Function Measure Classification system V. The literature appears to be most relevant for persons with Cerebral Palsy in classification systems II, III and IV. These children would be classified as mild and moderate in past terminologies. The children with CP in classification system I have very mild impairments and appear to be less well represented in the literature, since they may not have been included in earlier birth registries, and have a lifespan similar to the typical population (Williams and Alberman, 1998). Children in level II are ambulatory, but may have difficulties with stairs or uneven surfaces; children classified III use assistive devices to ambulate, and may loose mobility skills after age six. Children classified in IV will use powered mobility over distances. Using this lifespan approach could have a two fold impact on the understanding of treatment in infancy. First, long term information would be more relevant if based on the classification level of an infant and increase understanding of the lifetime influences of his/her disability. For the child who is classified as severely impaired, V, early classification would encourage a treatment focus on issues which will ensure quality of life, since these people have higher morbidity and mortality. The important issues stressed in the literature are lack of self-feeding, lack of mobility and potential respiratory problems (Williams and Alberman, 1998). Early treatment would focus on successful feeding and be aimed at 'head …