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Coping with Multiple Disabilities

Many spastic children may have to cope with two or more disabilities.

A spastic child has disorder of movement and posture. As Cerebral Palsy affects the brain, it is possible that apart from motor functions other functions may also be impaired. It is not uncommon to find CP children with poor vision, hearing, speech problems, or learning disability. These disabilities must be attended to early and if permanent solutions are possible, they must be sought. If this is done, the spastic child is given a better chance of empowerment.

Any special school that takes in spastics is geared to working with multiple disabilities. Spastic children must be under professional guidance if they have additional disabilities. We provide below some tips for understanding and helping these children when they are at home.

Vision Problems

Only rarely are CP children completely blind. But it is quite common for these children to have disordered movements of the eye muscles resulting in squint. Usually, minor corrective surgery can take care of this. Spastic children may also have short sight and need spectacles. It is important that a spastic child is assessed by an ophthalmologist.

I cannot remember how I felt when the light went out of my eyes. I suppose I felt it was always night and perhaps I wondered why the day did not come. --Helen Keller (a blind-deaf-mute who managed her disabilities to become an activist.)

A baby with vision problems perceives the world differently from the way we do. Objects appear hazy. It cannot be sure if you are smiling or frowning. It becomes more responsive to sounds and touch. This child needs to be cuddled and talked to a bit more. As the child grows up it picks up clues about emotions from the tone of the voice rather than the expressions from the face.

  • Toys: Give the child things which can make noises: musical toys, whistles, spoon and a vessel with which it enjoys clanging about.

  • Audio Inputs: You may be in the kitchen fixing a meal for the child. You are probably able to see the child waiting at the dining table clearly. The child may not be able to see you very well. It may see a fuzzy image and hear some sounds. Talk to the child and help him associate a cooker whistle and the smells of spices and oil with what you are doing.

  • Range of vision: Don’t expect the child to identify objects or people from a distance. The child may have to come quite close to the to the object (be it shoes, a pencil box, or personal belongings) to identify them. The person who goes to pick up the child from the school or day care centre must be told to look for the child, rather than wait at the gate in a crowd, expecting the child to come up to him.

  • Route Map: When you are taking the child to the school or the neighbourhood shopping complex, give the child some clues with which he can mark the direction to his house. If there is a big, unusual building that he can see, a signal where you stop, a bridge where traffic sounds are different point them out to him. A mentally active child will soon make its own route map based on sounds, smells and looming objects.

  • Moving space: The spastic child’s movements are awkward. With vision problems, the child is not going to be able to see objects lying about on the floor. It is important to keep the moving area clear to avoid accidents.

  • Learning Aids: Vision problems can be detected early and spectacles can be prescribed as soon as a child can manage them. If additional devices such as special magnifying glasses are required, a whole range is available.

Hearing Problems

A spastic child may have hearing loss due to damage to nerves from the ear to the brain. This is called “sensorineural” hearing loss and is difficult to remedy. Another kind of hearing impairment is caused by an interference in the conduction of sound waves to the inner ear, as in the case of ear blocks due to infection. This can be treated. However, a spastic child that is prone to throat and ear infections should be looked after with alertness.

  • Medical Assessment: When any hearing impairment is suspected, the first thing you should do is to get the problem medically assessed. The depth of the problem has to be observed: Is the child able to hear at all?, Is he able to hear loud sounds or not?, etc. Treatment, if possible, must be given without delay.

  • Communication: For the child to be socially acceptable the child must be able to communicate. Children with hearing loss should be encouraged to communicate. Speech therapy should begin early. Lip reading and sign language have to be worked out within the family, before the formal communication pattern.

  • Behavioural Problems: A child who lives in a silent or incomprehensible world,sees people around him being responsive to each other, but not to him. He is likely to demand attention. Aggressive behaviour and temper tantrums are common. Once the child is able to communicate reasonably well there is a good chance that these problems will lessen.

  • Hearing Aids: While a hearing aid helps the child hear better there is problem of feedback (a screeching sound that is continuously heard by the most hearing-aid users.) This is a source of discomfort for the child. Children who use hearing aid should learn to protect it from rain, excessive sweat and dust.

Try to set apart a time where you can teach the child with minimal ambient noise. Switch off all the noisy equipment (the ones that produce noises of low tones also). Sit the child in an upright position so that the hearing aid does not make jerky movements. Sit in front of the child in good light. Use enhanced lip movement and speak to the child. This can be done for a couple hours each day when the child is allowed to develop its language skills.

Speech Problems

Understanding the Problem

Look sharp for speech problems in the following cases:

  • Problems with feeding (sucking, chewing, and swallowing)
  • Problem with associating words and objects
  • A vocabulary of less than 30 words at age two
  • Is unintelligible and cannot frame phrases even at three.

There may be nothing wrong with your child at all. It is said that the great physicist Albert Einstein started speaking at five. Still, it is better to have the child checked up by an ENT/Audiologist.

One of the common speech problems spastic children have is dysarthia. Due to poor muscular co-ordination the rhythms of speech are distorted. The intonation may be different, the stress falling on the wrong word or syllable. The child may leave out some syllables.

Tips for Management

  • Take the child regularly for speech therapy. Practise with the child at home in short spells without straining the child.
  • Allow the child time to speak
  • Include the child in conversations.
  • If she is not being understood, ask again, and suggest the right word showing that she is being understood.
  • Repeat the mispronounced word the right way but do not say that the child is wrong.
  • Fill up gaps in communication with signs, gestures, and when possible with pictures.
  • Remember, the most important thing is to encourage communication.


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