“Cerebral palsy” evokes the locked in syndrome more than the infantile “cerebral palsy”. Indeed in the locked in syndrome one has a real paralysis, an inability to communicate between the brain and the body. Whereas what is called infantile "cerebral palsy" is in fact a “paresis”. The brain can continue to communicate with the body. The brain therefore has the intrinsic ability to improve this communication. What is called “cerebral palsy” should be called “cerebral paresis”.
There are two types of cerebral paresis: those that affect a child at birth or in the first years of life.(Infant cerebral paresis)
And those acquired after brain injury, stroke or tumors in the latter part of childhood or adulthood.
With children with cerebral paresis, we cannot use the word "re-habilitation" because they have not lost skills.
We also cannot for brain damage acquired later, because people won't regain their previous skills.
In both cases, we have to do a personal neuromotor-education
The difference
between child cerebral paresis and aquired adult cerebral paresis is the period of mourning. In stroke and brain injury, motor education often
begins with a phase of nervous breakdown and comparison with "her former
abilities".
While cerebral palsy
children start their motor education cheerfully (like all children in
the world). They later realize the limits of their abilities by comparing
themselves to others. (mimetic desire - rené Girard).
This may explain why the motor abilities of hemiparetic infant are much more extensive than the motor abilities of hemiparetic adults.
Motor education for people with brain damage is based on two fundamental things:
A space affording the posture
and an exhaustive collection of motor abilities (in which the physiotherapist will choose the next accessible skills)
- Affordance is the “capacity of an object to suggest its own use”. "Needs control the perception of opportunities (selective attention) and also trigger actions."
-Gibson The ecological approach to visual perception 1979-.
If the person feels the need to improve a posture, the physiotherapist must arrange the space that will lead to the improvement of this motor skills.
The physical therapist needs a gradually motor skill collection to present the right skill at the right time.
too easy, the person does not learn anything,
too hard she does not learn anything either"!
Mesure
et Sultana (1988) Ataxie et syndrome
cérébelleux–Masson-
Neurorehabilitation professionals
keep saying that there is not two similar CP or hemiplegia. But they often apply the same recipes for everyone. I tried to make a very large directory to identify a specific program for each.
I also noted the specific arrangements of the environment that we have built to make their postures possible.
The motor education of the person with cerebral palsy responds to his intention which responds to a necessity.
Then the learning takes place under two conditions:
- Repetition . "ubquitus law of practice".
Newell, A., & Rosenbloom, P. S. (1981). Mechanisms of skill acquisition and the law of practice. Cognitive skills and their acquisition, 1(1981), 1-55.
But repetition is boring (that's why you have to vary the playful situations).
- knowledge of result "a sine qua non of learning"
Annett, J., & Kay, H. (1957). Knowledge of results and 'skilled performance'.
Occupational Psychology 31, 69-79
I awarded 1 point for each skill acquired to introduce a challenge into the score. Since there are over a thousand skills listed; the physiotherapist can vary the situations at each session before beginnig again the cycle.
