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Running Head: CEREBRAL PALSY: NURSING AND THE PEDIATRIC CLIENT

Cerebral Palsy: Nursing and the Pediatric Client

Student: Nicholas Mackay
Student ID: N01042976
Date Submitted: November 20, 2015
NURS-209
Professor: Eva Braun
Humber College ITAL

Running Head: CEREBRAL PALSY: NURSING AND THE PEDIATRIC CLIENT

Cerebral Palsy- Nursing and the Pediatric Client

Cerebral palsy is a neurological disorder that results in a wide spectrum of mental and
physical impairments. Physically, it is characterized by stiff or spastic movements, seizures,
difficulty walking, drooling, urinary incontinence, dysphagia, and dysarthria. Mentally, it may
result in intellectual disabilities and abnormal sensory perceptions. It is caused by an atypical
development of the brain before birth or soon afterwards. This abnormal development can be a
result of birth asphyxia, genetic mutations, infections of the mother during pregnancy and
infections during infancy, and severe brain trauma from a fall or abuse (Rosenbaum et al., 2007).
Due to its early onset, cerebral palsy is always a pediatric health challenge. It is essential that the
nurse and a broad team of healthcare professionals intervene to ensure that the pediatric client
meets their best potential condition. This paper will focus on how the nurse can intervene to
assist the client while also outlining the role of the collaborative healthcare team and the broader
community resources that are available to help the client and their family.
The nurse is responsible for a variety of interventions when caring for a client with
cerebral palsy. The nurse must ensure that the environment is clear of objects that could trip or
injury the client during a seizure or muscle spasm. The clients nutrition and hydration status
should be monitored regularly because the clients difficulty swallowing can discourage a
sufficient intake of food and fluids. In addition, suctioning should be performed after meals to
prevent aspiration (Chambers, 1997). This paper, however, will focus on intervening to improve
the clients physical abilities.
The root cause of cerebral palsy is related to damage to the nervous system and yet this
damage cannot be repaired and therefore only the symptoms can be addressed. The most

Running Head: CEREBRAL PALSY: NURSING AND THE PEDIATRIC CLIENT

prominent of these symptoms are related to a reduced physical aptitude as a result of a loss of
muscle control and muscle strength (Rosenbaum et al., 2007). The nurse can intervene through
motion therapy. This includes range of motion exercises, proper positioning and activities that
involve fine motor skills. The range of motion exercises can be passive, in which the nurse
moves the clients limbs. The client can also be an active participant in which case the nurse
simply encourages the client to move and stretch their limbs. These range of motion exercises
should be performed every four hours. Fine motor skill exercises include drawing or colouring,
the client feeding himself, and encouraging the client to play with their toys. In order to
encourage the pediatric client to accept the nursing interventions it is important to make the
activities fun and to offer rewards when they comply with the regimen (Chambers, 1997). After
the exercises the client must be positioned properly while they rest and recover from their
exercises. In order to properly position a client with cerebral palsy the nurse ought to place the
client in as outstretched a fashion as possible in order to stretch the clients tendons and muscles.
Therefore, the legs and arms should lie flat and the feet should be in a state of plantar flexion.
Without motion therapy the client can develop a number of complications. The most
severe result of the client not undergoing motion therapy is an increased risk for contracture.
Contracture is a condition in which the muscles and tendons begin to shorten to such an extent
that the bones and joints can deform or even dislocate. In the long term this tension and pressure
on the joints can lead to osteoarthritis. In general, regular exercises that involve gross and fine
motor skills improve the clients mobility and ability to perform activities of daily living (Bax,
2005). This intervention allows the pediatric client to physically develop in a more normal
fashion. Cerebral palsy is a lifelong condition that requires lifelong care to maintain and improve
the clients ability to function. Ultimately, without this intervention it is likely that the client

Running Head: CEREBRAL PALSY: NURSING AND THE PEDIATRIC CLIENT

would be unable to feed himself, to cloth himself, or simply to walk around. Without these
exercises the client could eventually choose to move very little due to their stiffness and spastic
movements. This lack of movement could lead to muscle atrophy or pneumonia (Bax, 2005).
As important as the nurses interventions are there are other members of the collaborative
healthcare team whose strategies for care are essential for a pediatric client with cerebral palsy.
The physical therapist pursues a care strategy that is a more targeted and extensive version of the
intervention a nurse would perform for a client with cerebral palsy. They also perform physical
exercises to improve a clients ability to function. They identify specific problems and
restrictions related to movements and devise specific strategies to address these problems. They
identify environmental factors that might restrict physical activity. They may also determine
whether a mobility device such as leg braces would be appropriate.
The orthopaedic surgeon improves the physical ability of a client with cerebral palsy
through surgery. In cases in which physical therapy and other approaches are not sufficient,
orthopedic surgery is used to increase the clients range of motion. The nurses intervention
complements this approach. The surgeon can extend tendons, sever problematic muscles and
tendons, or even change where tendons attach to bones to reduce tension while retaining some
degree of functionality (Chambers, 1997). Scoliosis is common for those with cerebral palsy and
impairs mobility and physical activity in general. Scoliosis can also be addressed by the
orthopedic surgeon. After surgery the nurse will continue to intervene with motion therapy in
order to counteract the remaining effects of cerebral palsy.
The demands of a child with cerebral palsy on their family are considerable and the social
worker helps the family to cope with their childs condition. The social worker provides the

Running Head: CEREBRAL PALSY: NURSING AND THE PEDIATRIC CLIENT

family and client with counselling, support groups, education, and referrals (Chambers, 1997).
These services are essential to maintaining and improving the clients physical ability because
they educate the family and client about these essential exercises. These services also help to
provide emotional support and that helps to maintain motivation for the taxing daily exercises
that the client and family perform when outside the clinical setting.
The entire collaborative team is potentially involved with connecting the client with
community resources. The most significant and practical community resource is the Ontario
Federation for Cerebral Palsy. This organization provides generous funding for assistive devices
for mobility but also respiratory equipment, communication aids, home accessibility devices, and
funding for beneficial activity enrichment services of the clients choice. The organization gives
advice as well. Clients with cerebral palsy can easily become socially isolated and inactive. Best
Buddies Canada is active throughout Toronto and connects people with intellectual and physical
disabilities with students who act as their companions. Its a simple program that provides for an
essential need of all people- a sense of belonging and connection. Lastly, Camp Awakening is a
camp for children with physical disabilities. This camp setting cultivates a sense of independence
and identity while surrounding the pediatric client with a supportive environment and children
that the client can feel normal around.
There is no cure for cerebral palsy but through the correct strategies and interventions the
physical abilities and well-being of the nurses client can be improved. This improvement takes
the entire collaborative healthcare team. All children must have a good life outside of the hospital
and community resources are a key to achieving a better life for the client and their family. As
difficult as this condition is, there is real hope for improvement if we work together.

Running Head: CEREBRAL PALSY: NURSING AND THE PEDIATRIC CLIENT

References
Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, N., Dan, B., ... & Damiano, D.
(2005). Proposed definition and classification of cerebral palsy, April 2005. Developmental
Medicine & Child Neurology, 47(08), 571-576.
Best Buddies Canada. (n.d.). Retrieved November 18, 2015, from http://bestbuddies.ca/
Camp Awakening. (n.d.). Retrieved November 17, 2015, from http://www.campawakening.com/
Chambers, J. (1997). Cerebral Palsy: A Complete Guide for Caregivers.
The Ontario Federation for Cerebral Palsy. (n.d.). Retrieved October 16, 2015, from
http://www.ofcp.ca/
Overview of Cerebral Palsy. (n.d.). Retrieved October 16, 2015, from
http://cerebralpalsy.org/about-cerebral-palsy/definition/
Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., ... & Jacobsson,
B. (2007). A report: the definition and classification of cerebral palsy April 2006. Dev Med Child
Neurol Suppl, 109(suppl 109), 8-14.