Child with Cerebral Palsy

On my paeds placement, one of my clients was a teenager with a diagnosis of Cerebral Palsy (CP). It was my first session with her, so I did a full subjective and objective assessment under the supervision of the FCE. From her notes, I gathered that she had moderate intellectual disability, and required assistance with speech and comprehension.

Initially the Assessment went smoothly, and she could understand the instructions I gave and performed them correctly. She was also able to hold a decent conversation and laughed at jokes. However, when I was doing Manual Muscle Testing (MMT), my client seemed to become increasingly confused. She paused for a long time after each instruction before doing them, yet performed incorrectly most of the time. She found it most difficult to understand ‘hold it there; don’t let me move you’ (isometric resistance). I then modified my instructions, and tried a variety of ways (eg demonstration, visual, tactile, and verbal prompts, and used other illustrations) to explain my instructions to her. Only after many trials did she manage to perform them correctly.

I was baffled as to which part of the messages/instructions broke down. From her initial performance I thought it would have been easy for her to understand my instructions and do them without difficulty. After discussing this with my supervisor, I learned that these situations are common when treating children with disabilities. Despite the many factors that could have potentially obstructed her comprehension or execution of the tasks, my instructions (in the future) must be slow, clear and succinct at all times. It is also important that I be creative in the way I deliver the instructions. More common than not, it is about getting to know the client over time and modify my language to suit each individual.