classroom health care plan

Cerebral Palsy
Classroom Health Care Plan

Name:________________________________________ Effective Date:_________________________
Parent(s):_______________________________________ School: _____________________________
Home Phone:________________________ Bus: __ yes __ no
Emergency/Cell:_________________________ School Nurse:____________________ Office #_________
DOB:________________ Doctor:_______________________________ Office #________________
Allergies:____________________________________________ Preferred Hospital:____________________

Cerebral Palsy (CP) refers to a group of conditions that have to do with an injury to the brain.
(_____________) was born/ injured and as a result has some motor difficulties. CP is characterised by involuntary movements. It is a non-progressive neurological condition that occurs as the result of brain injury in the motor centers and is grouped in types depending on the involvement. (_________________) has involvement in _____________________ extremities. (________________) has spasticity, which refers to stiffness of the muscles (hypertonicity). The muscles
and nerves are normal, but the brain is unable to control the muscles causing increases stiffness especially in the arms and legs, and less in the trunk. (______________) has poor control of muscle force and decreased ability to grade movement. The stiffness is affected by his/her environment, effort, and emotional state. The limbs are often held in ways that interfere with functional use of the extremity. (________________) has hypotonia, which is decreased level of stiffness with less control of the muscles.
(________________) has decreases trunk in stability and uses bursts of muscle activity to initiate movement that looks uncoordinated and clumsy. (______________) cannot sustain muscle activity and the low muscle tone interferes with postural muscles and using extremities for function. (_______________) may appear lazy or tired all the time and may have a flat affect due to the hypotonia. (___________________) has athetoid cerebral palsy, which is characterized by involuntary, sometimes
writhing movements, especially of the hands caused by fluctuating tone in the muscles. Voluntary activity or emotional stress can make these movements more pronounced. (______________) has ataxia, or a broad-based, lunging walk (gait) with balance difficulties. This can be
movement done with poor timing and speed of the motor units. Can be seen in the head and trunk and in fine and gross movements as well. It effects coordinated movements including fine motor, balance and equilibrium reactions. (______________) can be fearful of movement and can perceive touch as noxious. (________________) has mixed type cerebral palsy, which is a combination of spasticity and athetosis or
ataxia. Spasticity refers to stiffness of the muscles (hypertonicity). Athetosis refers to involuntary, sometimes writhing movements. Ataxia refers to a broad based, lunging walk (gait), with balance difficulties. (________________) needs ongoing assessments: 1. Strength: the amount of force needed to perform and hold a movement or position.
2. Endurance: how long a muscle moves or holds a position before fatiguing.
3. Paralysis: loss of movement ranging from total to mild loss of movement. This can involve one to
4. Tremors: involuntary movements that occur with movement or at rest. Tremors can be a side effect
of medications and should be reported if they become worse. Motor dyspraxia: poor motor planning ability and difficulty with executing planned, purposeful movements. Common health problems associated with cerebral palsy include: vision problems such as eye muscle
imbalance (strabismus), refractive errors (near sighted, far sighted), poor tracking related to muscle in-coordination, and jerking eye movements (nystagmus); hearing problems related to facial abnormalities and ear infections; respiratory infections related to aspiration of food, fluid and saliva and decreased immune response; frequent surgery for orthopedic problems and other defects; inadequate nutrition related to increased caloric needs; dehydration related to poor swallowing and drooling; and seizure disorders. There is no "cure" for cerebral palsy. Treatment usually involves many disciplines and is focused on
improving basic functioning, including activities of daily living. Surgery can prevent spinal deformities. When contractures cause severe movement problems, surgery to lengthen muscles and tendons
may be recommended
. Surgically lengthening a muscle makes it weaker and may require months
of recovery. Whenever possible, therefore, doctors try to fix affected muscles with a single surgery.
If more than one procedure is required, operations usually are scheduled as close together as
Dorsal root rhizotomy treats spasticity in the legs by selectively cutting nerves that overstimulate
leg muscles.
Stereotactic neurosurgery may improve rigidity and tremor. The area of the brain treated controls
the part of the body meant to be improved. A head CT scan is performed to produce images of the
brain. Coordinates of the location to be treated are moved to a stereotactic frame. The frame is used
like a map to guide an electrode to the target area in the brain. An electrical impulse is sent through
the electrode and into the brain tissue to change the brain cells.
Problem: Seizures
Problem: Mobility
Goal: To be aware of various disabilities and types of motor impairment

1. (___________) has difficulty with ambulating. (____________) uses a wheelchair for 2. (_______________) will require transportation because of the difficulty of getting to school related a. He/she will require assistance getting on and off the bus. b. He/she will require a seat belt on the bus. 3. (________________) has difficulty moving from one class to another. a. It is necessary that (____________) be allowed to leave class five minutes early and arrive five minutes late. This will not be considered tardy. b. (____________________) requires a peer buddy to assist with class changes. c. Due to a lack of strength, as much as possible, classes should be located in close proximity to each other and with as little stair climbing as possible. d. Arrangements should be made ahead for special provisions during fire and disasters drills, 4. (_______________) may/may not require modifications in regular PE activities. a. Consultation by an adaptive PE specialist is recommended, to implement simple b. Swimming classes are recommended, when possible, as part of the PE curriculum. c. Follow physician's written recommendations for modifications in physical activity. 5. (_____________) has difficulty carrying books, lunch tray and other items. a. A peer will be assigned to assist with class changes and lunch. b. (______________) should be given two sets of books, one for school and one for home. 6. (_________________) has problems with manual dexterity, such as writing, opening lockers, a. An occupational therapist should evaluate for environmental modifications and useful adaptive aids such as: a pencil grip, soft leaded pencils. Special scissors, key boarding, toilet accessories, eating utensils, etc. b. (___________________) should be given extra time to complete tests. c. (___________________) should be allowed to dictate notes d. (______________) requires shorter homework assignments and modified written work. He/she should avoid repetition, but make sure he/she has the concept. e. Assistance with using the bathroom is required. (________________) requires a bathroom 7. (_____________) needs careful positioning due to muscle _________________________. a. (__________________) needs extra support for his arms such as on top of the desk. b. (__________________) may need to stand, or change position at frequently.
Problem: Incontinence
Goal: Maintain skin integrity.
a. Notify parents and school nurse of any skin redness (lasting more than 20 minutes) or skin.
Problem: Relaxation medications for muscle spasms
Goal: Prompt recognition and reporting of unwanted side effects.
1. (___________) takes Lioresal (baclofen) to decease spasticity. It works on the spinal cord to
decrease muscle tone and relieve muscle spasms. a. Side effects that must be reported to parents include: drowsiness and lethargy. b. Educational implications of Lioresal include sedation but this tends to disappear after initial 2. (_____________) takes Valium (diazepam) to decrease spasticity.
a. It is important that this medication is not withdrawn suddenly. b. Side effects that should be reported promptly to parents include: drowsiness, trouble walking, fainting, slurred speech, blurred vision, or tremor. c. Educational implications of valium include: sleepiness and lethargy. 3. (_____________) takes Dantrium (dantrolene) to decrease spasticity. It works directly on the
a. Side effects of this medication included: disorders to liver function. b. Promptly report any yellowing of skin or whites of eyes (jaundice) to parents. c. Educational implications of Dantrium include: reduction in voluntary muscle control. Students on Dantrium may not be able to function as well but their care may be easier due to decreased muscle tone. 4. Botox injections have been used to treat some of the effects of cerebral Palsy. When Botox is injected into the muscle, it causes it to relax. This causes a reduction in muscle spasms and stiffness, allowing therapists to work with cerebral palsy patients in stretching the muscles. Botox injections are not a cure for cerebral palsy, and treatment typically needs to be repeated every three to six months.
Problem: Choking
Goal: Prevent choking.
1. (_______________) has a history of choking on food and fluid. a. Trained staff should supervise or be available during snack and lunch periods. b. (_____________) requires a bulb syringe or suction device to be available at all times. 2. Proper positioning and feeding techniques are recommended. The school nurse and/or occupational/physical therapist should be consulted regarding positioning, feeding, and adaptive aids. 3. (___________) should be fed in an upright position with head and neck upright (not extended). 4. (________________) requires all foods be soft/pureed. 5. Allow ample time for snack and lunch to avoid choking.
Problem: Inadequate nutrition
Goal: Aid to encourage growth
1. Children with cerebral palsy, especially the spastic type, burn more calories to do the same task as 2. (______________) requires a mid-morning and mid-afternoon snack to increase ability to learn 3. (_______________) requires and extended lunch period to maintain an adequate food intake. 4. (________________) requires monitoring of food intake. Problem: Dehydration due to poor swallowing and drooling
Goal: Prevent dehydration.
1. (__________________) loses a lot of fluid due to excess drooling. 2. (__________________) requires a mid-morning and mid-afternoon drink break to avoid dehydration. This may be increased during hot weather or strenuous activity to avoid heat exhaustion. 3. (_____________) requires lubrication of mouth and lips with _______________ to prevent 4. (____________) requires a minimum of ___________ fluids per day.
Problem: Oral Care
Goal: Promote good oral hygiene.
1. Children with cerebral palsy have a tendency to develop more cavities because of irregularly developed dental enamel. In addition, poor muscle control can lead to tooth grinding and dental accidents. 2. (____________) should have a program of oral care (tooth brushing) after lunch. The school nurse and/or occupational therapist should be consulted as to staff training and adaptive aids. 3. School staff must follow procedures to prevent transmission of diseases. Body fluid precautions are 4. (______________) is medicated with Dilantin for seizure control. Dilantin causes uncontrollable
gum enlargement (gingival hyperplasia). Good oral hygiene will reduce the inflammation associated with this disorder.
Goal: Recognise endurance limitations.
1. (________________) tires easily and may have difficulty keeping up physically and academically without adjustments to his/her day. (See interventions for mobility in this care plan.) 2. (________________) requires a rest period for _________ minutes every day.
Problem: Visual difficulty
Goal: Reduce barriers to learning.
1. (____________) has difficulty seeing long distances. a. Allow (______________) to sit where he/she can see well. 2. (______________) eyes tire easily and vision ability varies with this fatigue. a. Long reading assignments may have to be altered (reduce assignments, allow another student to read lengthy assignments aloud). Problem: Skin breakdown
Goal: Prevent skin breakdown.
1. If (_________________) sits in one position all day, he/she is putting excessive pressure on one area of the body. This pressure prevents circulation of blood, which deprives the skin of oxygen, and it dies. This dead area will lead to a pressure sore which is extremely difficult to heal. Pressure sores can lead to infection, limb loss, and even death. a. Reddened or white patches that won't pink up in a 20 minutes. b. If symptoms of redness are present, remove the item that is causing pressure. Notify parent of problem, as this may require refitting of the item. c. If you see skin sores and/or drainage, this requires immediate attention. Contact parent and a. Observe where braces, shoes or other leg supports may rub on the student. b. If symptoms or redness are present, remove the item that is causing pressure. Notify parent, school nurse and physical therapist of problem. Refitting of the item may be required. c. Have the child change position every two hours. For example, if sitting, change to side lying or allow out of wheelchair for 15 minutes. d. If pressure becomes a problem on the buttocks, obtain a physical or occupational evaluation e. Do not massage the affected part as this encourages sores to form. f. Keep the area clean and dry. Montgomery County Public Schools 07/22/09


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