AGuideto

Cere b ra l Pa l s y

your pathway to understanding

This edition of A Guide to Cerebral Palsy has adapted material from several excellent publications and websites,
which outline the causes and effects of cerebral palsy:
A Guide to Cerebral Palsy
Dr. A. Mervyn Fox
Canadian Cerebral Palsy Association, 1991
Cerebral PalsyFacts and Figures
United Cerebral Palsy
(www.ucp.org)
Cerebral Palsy-Information kits for Educators and Parents
Cerebral Palsy Association of Manitoba, 1989
Cerebral Palsy Magazine
(www.cerebralpalsymagazine.com)
Children with Cerebral PalsyA Parents Guide
Elaine Geralis, 1998
National Institute of Neurological Disorders and Stroke
(www.ninds.nih.gov)
Ontario Federation of Cerebral Palsy
(www.ofcp.on.ca)
Published: 2006
Cerebral Palsy Association of BC
Written by Nan Colledge, 1999
2006 Addition Revised by: Jasmine Parbhu, members of the
CPABC Board, and CPABC staff

A Guide to

Cerebral Palsy
C e r e b r a l Pa l s y A s s o c i at i o n o f B r i t i s h C o l u m b i a

3rd edition 2006

Funding graciously provided by
The Hamber Foundation

The Cerebral Palsy Association of BC

Who We Are
The Cerebral Palsy Association of BC is an independent, not-for-profit Association directed by a volunteer Board of Directors that includes:
those living with CP, parents of children and youth with CP, and interested community members.
We began in 1954, thanks to a group of concerned parents wanting the
best possible opportunities for their children living with Cerebral Palsy.
Today we provide: support, education and information to over 12,000
people across BC living with CP. This support is also extended to family
members, professionals, students, other organizations, and community
groups.
Our Mission

To raise awareness of Cerebral Palsy in the community

To assist those living with Cerebral Palsy to reach their maximum
potential
To work to see those living with Cerebral Palsy realize their place as
equals within a diverse society

Guiding Principles
As the Knowledge Centre for Cerebral Palsy in the province of British Columbia, we are committed to the following Guiding Principles:

We believe in providing accurate information concerning both the

clinical and experiential aspects of living with Cerebral Palsy.
We believe that all individuals living with Cerebral Palsy, including:
family, friends, or others within the CP Community, should have
equal access to programs and services that will both meet their present needs, and help them to achieve long term life goals.
We believe that those living with Cerebral Palsy are part of the spectrum of human diversity, and therefore, do not need to be made
to conform to a standardized norm. We believe in the normality of
diversity.
We believe that all people have unique skills and knowledge to offer
society, thanks to differing age, ethnicity, cognitive ability, gender,
and physical mobility.

Contents
Introduction 4
What is Cerebral Palsy? 5
Common Misconceptions About CP 6
How Many People Have CP? 7
What Causes Cerebral Palsy? 7
Is CP Preventable? 9
Diagnosis of CP 9
The Human Brain 10
Types of CP 11
Treatment and Management of CP 13
Living with CP 20
A Parents Perspective 22
Aging and CP 25
What Research is Being Done on CP? 27
Additional Websites 28
CPABCYour Knowledge Centre 29
The Professional Team 30
Glossary 32
CP Associations in Canada 34

Notes on st yles used in this guide

To make this text easier to read:
The abbreviation CP is used throughout in place of Cerebral Palsy.
CP affects roughly equal numbers of men and women. Rather than use
he/she, he and she are used in alternating sections.

Introduction
Every person who has Cerebral Palsy (CP) is unique. Cp describes a variety of movement disorders, ranging from mild to severe, with differing
causes affecting individuals in many ways. If you are new to Cerebral
Palsy, you may find yourself struggling with a bewildering number of
medical and technical terms.
In Canada, people with disabilities have access to one of the widest ranges of support and therapy services, equipment, medical intervention,
educational and employment opportunities in the world. While having
CP does present some additional challenges, it does not need to be a
barrier to leading an enjoyable and productive life. Being well informed
about the options and opportunities available is a first step to successfully facing these challenges.

After Ive been tucked into bed at the end of the day, what
matters most is whether or not Im happy with who I am
and what Ive achieved, disability and all.
T. van der Kamp


What Is Cerebral Palsy?

Cerebral Palsy is the result of an injury to the developing brain at any
time during pregnancy, birth, or until the age of three. The injury to the
brain interferes with messages from the brain to the body affecting body
movement and muscle coordination. CP does not damage a childs muscles or the nerves connecting them to the spinal cordonly the brains
ability to control the muscles.
Depending on how much of the brain was affected, the effects of CP vary
widely from individual to individual. At its mildest, CP may result in a
slight awkwardness of movement or hand control. At its most severe, CP
may result in virtually no muscle control, profoundly affecting movement and speech.

Depending on which areas of the brain have been injured, one or

more of the following may occur:

Muscle tightness or spasm

Involuntary movement
Difficulty with gross motor skills such as walking or running
Difficulty with fine motor skills, for example, writing and speaking
Abnormal perception and sensation

These effects may cause associated problems, for instance, difficulties in

eating and swallowing, poor bladder and bowel control, and breathing
problems.
Many, but not all, individuals who have CP have secondary medical
conditions and disabilities:

Growth problems (failure to thrive)

Seizures or epilepsy
Learning disabilities
Hearing impairment
Vision problems

Common Misconceptions About CP

Myth: CP is genetic.
Fact: CP is not genetic. It cannot be passed from parent to offspring. It is
the result of injury to the brain before, during, or after birth.
Myth: CP is hereditary.
Fact: CP is not inherited from one generation to the next.
Myth: CP is life-threatening.
Fact: People diagnosed with CP can have a normal life span.
Myth: CP is usually the primary cause of death.
Fact: Because CP is not a sickness or disease, and not progressive, it is not
the primary cause of death.
Myth: CP is a disease.
Fact: CP is not a sickness or disease that can be passed on from one individual to another or be cured. It is a life-long condition.
Myth: CP is progressive.
Fact: Injury to the brain is a one-time event, so the condition will not
worsen, change or expand, although the effects of CP may change over
time. Some may improve; for example, a child whose hands are affected
may be able to gain enough hand control to write and to dress himself.
Alternatively, muscles may tighten and can cause problems in the hips
and spines of growing children. This may require orthopedic surgery to
correct.
Myth: CP is always preventable.
Fact: There are measures that may be taken to prevent some cases of CP.
However, despite best efforts of parents and physicians, children are still
being born with CP.
Myth: The physical disabilities of CP are an indication of level of intelligence.
Fact: People with CP can have difficulty speaking, but this does not equate
to low intelligence or low cognitive levels for their age. Many people living with CP have average to above average intelligence levels.
Myth: CP means limb paralysis.
Fact: The muscles in limbs affected by CP are not paralyzed. Pain, heat,
cold and pressure are felt but there can be diminished sensation.


How Many People Have CP?

It is difficult to estimate exactly how many people live with CP. Many
people with mild CP are never diagnosed, while others may have multiple disabilities, which overshadow their CP.
Worldwide, more than 15 million people have CP. In Canada, it is
estimated that one out of every 500 babies, and up to one in three lowbirth-weight babies, are affected to some extent. Presently, there are over
50,000 Canadians living with CP.
A large number of risk factors, individually or in combination, can injure the developing brain, which in turn may produce CP. Risk factors
are not causes but variables which, when present, increase the chance of
something occurringin this case, CP. Just because a risk factor is present does not mean CP will occur; nor does the absence of a risk factor
mean that CP will not occur. If a risk factor is present, it serves to alert
parents and physicians to be even more observant to the infants developmentbefore, during, and after birth.

What Causes Cerebral Palsy?

Risk factors that can lead to birth complications resulting in CP include
the following:
During Pregnancy:
Anything, which tends to produce a low birth weight baby, will increase
the likelihood of CP.
Factors during pregnancy which may increase the risk of CP include:

Multiple births (twins or triplets)

A damaged placenta which may interfere with fetal growth
Infections (e.g., rubella)
Poor nutrition
Exposure to toxic substances, including nicotine and alcohol
Maternal diabetes, hyperthyroidism or high blood pressure
Premature dilation of the cervix leading to premature delivery
Biochemical genetic disorders

Chance malformations of the developing brain

Rh or A-B-O blood type incompatibility between mother and infant
Sexually transmitted diseases (e.g., gonorrhea, herpes)


During labour:

Premature delivery
Abnormal positioning of the baby (such as breech or transverse lie)
which makes delivery difficult
Small pelvic structure
Rupture of the amniotic membranes leading to fetal infection
Prolonged loss of oxygen during the birthing process
Effects of anesthetics or analgesics
Severe jaundice shortly after birth
Low Apgar score

Post-natal (03 years old) risk factors:

CP can occur if a child suffers from an injury to the brain due to:

Infections such as meningitis

Brain hemorrhages
Nervous system malformations
Head injuries following falls, car accidents or
abuse
A lack of oxygen (asphyxia) due to accidents
such as drowning
Poisoning
Seizures

In some cases, a difficult labour may lead to a lack

of oxygen to the brain, which can be an important contributing factor in the development of CP.
Other people with CP may be born prematurely. Still other families sail
through straightforward pregnancies and deliveries, only to have their
child later diagnosed with CP out of the blue.
Every person with CP asks, Why did this happen to me? and every
parent of a child with CP asks, Did I do anything wrong? In most
instances, these questions will never be answered to your satisfaction.
As one mother said, When I stopped saying why me? I was ready to
accept my sons CP and look to the future.

Finding out your child has a disability: its not the end
of the world.
Dr. Mark Nagler, Ph.D.


Is CP Preventable?
Several of the risk factors for CP are preventable or treatable:

Safety campaigns give advice on protecting children from accidents

and injury. Head injury can be prevented by regular use of child safety
seats when riding in a car or use of helmets during bicycle rides.
In addition, common sense measures around the householdclose
supervision during bathing and keeping poison out of reachcan
reduce the risk of accidental injury.
Newborns with jaundice can be treated effectively with phototherapy.
Rh incompatibility is easily identified by a simple blood test routinely
performed on expectant mothers. Pregnant women are tested for the
Rh factor and, if Rh negative, they can be immunized within 72
hours of giving birth. This prevents any adverse consequences of
blood incompatibility in a subsequent pregnancy.
Rubella, or German measles, can be prevented if women are
vaccinated against this disease before becoming pregnant.
Women should begin getting regular medical care as soon as
they know they are pregnant, and should avoid smoking, alcohol
consumption, and drug abuse. Education programs stress the
importance of optimal well-being prior to conception and adequate
prenatal care.

These measures have undoubtedly prevented many children from a brain

injury resulting in CP. Other developmentssuch as neonatal intensive
carehave enabled very low birth weight babies to survive. However,
despite the best efforts of parents and physicians, children may still be
born with CP. As research uncovers more about the causes of CP, doctors and parents will one day be further equipped to help prevent this
condition.

Diagnosis of CP
Doctors diagnose CP by testing an infants motor skills and looking carefully at the infants medical history. In addition to checking for symptoms
of slow development, abnormal muscle tone, and unusual posture, a
physician also tests the infants reflexes and looks for early development of
hand preference.
The doctor may also order specialized tests to learn more about the possible cause of CP. CAT Scans (Computerized Axial Tomography) and
MRI s (Magnetic Resonance Imaging) can identify lesions in the brain.


This technology enables some children who are considered at risk of

having CP to be diagnosed very early. However, for the majority of people with CP it will be months, and sometimes years, before a diagnosis
is confirmed.
It should be noted that in many cases, physicians may be hesitant to
make a diagnosis of CP until the child reaches 1824 months of age, for
fear of a misdiagnosis because a delay in development that occurs early
in the childs life can later disappear (i.e., the child catches-up).
A child with CP will probably be delayed in reaching her milestones
such as rolling over, sitting and standing. A baby may feel unusually stiff
or floppy. A diagnosis of CP is unlikely to be given until the childs progress is observed over a period of time and other conditions are ruled out.
Many parents report that this waiting periodwhen they know their
child is not developing at the same speed as her peers, yet not knowing
whyis particularly stressful.

The Human Brain

10

Types of CP
Just as there are many different causes of CP, CP also takes many forms.
Every person with CP is a unique individual, but is likely to be classified
as having a particular type of CP. Classification is related to the type of
movement disorder and/or by the number of limbs involved.
Classification by Number of Limbs Involved

The most important factor in a familys success is the

motivation to succeed.
Dr. Mark Nagler, Ph.D.

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Classification By Movement Disorder

The location of the brain injury will determine how movement is affected.
Spastic Cerebral Palsy
Spastic CP is the most common type, affecting about 75% of the CP population, and is caused by injury to the motor cortex. Spastic muscles are tight
and stiff, which limit movement. Normal muscles work in pairswhen
one group contracts, the other group relaxes to allow free movement
in the desired direction. Spastic muscles become active together and
block effective movement. This muscular tug-of-war is called co-contraction. Spasticity may also involve difficulty in controlling the mouth and
tongue. Spasticity may be very mild and affect only a few movements, or
very severe and affect the whole body. The amount of spasticity usually
changes with time (i.e., aging), but may also change with environmental
conditions, such as weather (cold/heat), lighting (sunlight, halogen
lighting), and stimulants (pop, coffee) to name a few.
Athetoid (Dyskinetic) Cerebral Palsy
Athetoid CP results from damage to the basal ganglia in the midbrain,
and leads to difficulty in controlling and coordinating movement. Uncontrollable movements may be fast and jerky or slow and writhing.
People with this type may have trouble sitting or walking. They may
also have a hard time speaking due to problems controlling the face and
tongue muscles. This type affects about 25% of those diagnosed with CP.
Ataxic Cerebral Palsy
Ataxic CP is the least common type, affecting about 510% of the CP
population, and is caused by damage to the cerebellum. People with this
type have a disturbed sense of balance and depth perception (i.e., they
have difficulty judging how close or far away things are). They may also
have difficulty walking, often walking with a limp, and difficulty with
tasks requiring small, coordinated movements such as writing or reaching and grasping objects smoothly.
Mixed-type Cerebral Palsy
When areas of the brain affecting both muscle tone and voluntary movement are affected, a diagnosis of Mixed-type CP may be given. Usually
the spasticity is more obvious at first, with involuntary movement increasing as the child develops.

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The classifications of movement disorder and number of limbs involved

are usually combined (e.g. spastic diplegia). These technical words can
be useful in describing the type and extent of CP, but they are only labels.
A label does not describe an individual.

Treatment and Management of CP

CP is not a curable condition. However, there is much that can be done
to lessen the effects of CP and to help people lead independent lives.
The word management is much preferred to treatment, as management refers to minimizing and preventing deformities, and helping the
child achieve his maximum potential in growth and development. The
earlier management begins, the better chance a child has of overcoming
developmental challenges and learning new ways to accomplish difficult
tasks.
There is no standard therapy that works for all people.
Specific interventions for CP are based on:

Your childs age, overall health, and medical history

The extent of the condition
The type of CP
Your childs tolerance for specific medications, procedures or
therapies
Expectations for the course of the condition
Your opinion or preference as parents/caregivers

Once your childs unique needs and impairments are identified, a team
of health care professionals will work together to create an individual
intervention plan to address your childs needs. A typical intervention
team may include a physician/paediatrician, orthopaedist, physiotherapist, occupational therapist, speech and language therapist, social worker,
psychologist, and educator. See The Professional Team (p.30) for further information. Families or caregivers of individuals with CP are also
key members of the intervention team, and should be involved in all
steps of planning, making decisions, and applying treatments.
Individual/Family Supports
People living with CP, and their families, may need support to adjust to
this condition and all it entails. Parents and relatives may be angry their
child has CP or they may feel guilty or overwhelmed. Brothers and sisters
of children with CP may also need extra support.
13

Talking to a social worker, psychologist, or family therapist may help. In

addition, many people with CP and their families may find encouragement through support groups or simply interacting with other people
living with CP.
Note: For information on local and on-line support groups, please contact the CP Association of BC, or visit www.bccerebralpalsy.com.
Essential to every age, every challenge, every crisis, are the connections
we have formed with other parents of children with disabilities. These
connections come naturally: in clinic lines, preschool pickups, and all
other occasions when we parents are shepherding our children with disabilities through life.

M. Somoza, parent of twin girls with CP

Therapy
Physical Therapy (PT) also called Physiotherapy, aims to help people
achieve their potential for physical independence and mobility. Physical Therapy, uses exercise and activities to improve range of motion and
other gross motor functions.
Occupational Therapy (OT) designs purposeful activities to increase independence through fine motor skills. OT s help children to use adaptive
equipment such as feeding, seating and bathroom aids.
Speech/Language Pathology (SLP) aims to help children communicate
with others. A child may only need help to overcome a slight articulation
problem, or she may not be able to communicate verbally and require a
non-verbal communication system. Alternative communication systems
include low-technological picture and symbol boards, to high-technological eye-gaze systems, blissymbol boards, and electronic voice
synthesizers.
Acupuncture involves inserting specially designed fine needles into specific areas of the body for therapeutic uses, to relieve muscle pain, or as
a regional anesthetic.
Aquatic Therapy involves PT in a warm water pool. It is not necessary to
know how to swim to do aquatic therapy. It can help relax muscles, improve body posture and balance, decrease muscle spasms, and increase
circulation.

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Biofeedback techniques can improve control over body movements by

increasing the concentration of mind over body.
Conductive Education does not involve directly changing a certain disability; rather it involves teaching those with motor disabilities to carry
out coordinated and integrated actions through properly-guided, understandable education applied to daily routines and play. (Peto Institute)
Hippotherapy involves therapeutic horseback riding.
A horses walk provides sensory input through
movement that is variable, rhythmic, and repetitive.
Hippotherapy can improve balance, posture, mobility, and function.
Hyperbaric Oxygen Therapy (HBOT) involves
breathing pressurized 100% oxygen in a special
chamber. HBOT can help heal damaged tissues,
decrease swelling, and improve circulation.
Massage Therapy can benefit people living with CP by helping them relax
tense muscles, relieve muscle spasms and cramps, strengthen muscles, keep
joints flexible, and increase circulation.
Music Therapy uses music for the treatment of secondary, developmental
or behavioral disabilities.

Neurobiofeedback involves training the brain to help improve its ability to regulate bodily functions. It helps with seizures, lowers stress and
anxiety, helps deal with depression, and manages pain and emotions.
Recreation Therapy uses sports and leisure activities as a form of therapy.
Recreational therapists work with children on such activities as dancing,
swimming, horseback riding, art, horticulture, and any other hobby the
child is interested in. Other activities may also include traditional sports
with or without equipment aids.
Sensory Integration Therapy helps to develop better sensory perception. The therapy, which is guided by the child and their interests, can
improve balance and steady movement, as well as help children learn
sequences of movements.

15

Orthotic & Splints

Most children with CP will be prescribed orthotics, casts or splints to
supplement their therapy programs. These should be custom made for
your child as they help to provide stability, keep joints in position, and
help stretch muscles.
Medications
Your child may take medication for secondary conditions sometimes
associated with CP, such as seizures. Drugs may also be prescribed to
control spasticity, particularly following surgery. Medications used most
often include:

Diazepam (Valium): acts as a general relaxant of the brain and body

Baclofen (Lioresal): blocks signals sent from the spinal cord to contract the muscles
Dantrolene (Dantrium): interferes with the process of muscle
contraction

Anticholinergic drugsincluding Trihexyphenidyl, Benztropine, and

Procyclidine Hydrochlorideare sometimes prescribed to help reduce
abnormal movements in individuals with athetoid CP.
Injections
Occasionally, physicians use alcohol washesor injections of alcohol
into a muscleto reduce spasticity for a short period. This technique is
most often used when physicians want to correct a developing contracture.
Botox has been proven effective for the use in the treatment of many other
hyperactive, spastic muscle conditions and has been studied extensively
in Cerebral Palsy to treat muscle stiffness in children two years of age or
older.
Today, Botox is used in the treatment of dynamic equines foot deformity due to spasticity in pediatric Cerebral Palsy patients, two years
of age or older for the following reasons:

16

Significantly improved gait pattern

Improvement in ankle position
Reduction in equinus
The improved gait pattern enables patients to perform daily personal
activities more independently

Decreased pain in stiff muscles

Reduction in spasticity makes patient care easier
Shown to help delay surgery until the child is older

Children best suited to Botox treatments are those:

Two years of age or older

With muscle stiffness interfering with function
Where calf length maintenance is required
Who require early, conservative treatment
Where improvement in gait is desired (toe walkers)
Supported by a physiotherapy program
With pain in stiff muscles

How will Botox help with overall treatment?

Botox can help by reducing the over activity of muscles very quickly. In
fact, most people begin to see results within the first two weeks after injection. Excerpt from: Cerebral Palsy and the Role of Botox. Allergan, 2002
Surgery
Surgery may be recommended when contractures are severe enough to
cause movement problems.
It is important to understand that opinions will vary from doctor to doctor;
therefore, it is recommended that as parents of children with CP you:

get opinions and advice from various sources (not just doctors)
seriously consider the benefits and consequences of a particular surgery
before proceeding
consult with and consider the opinion of your child, and ensure that he
understands how he will be affected by surgery in the near- and long-term
future

Orthopedic and soft-tissue surgery can help counter the damaging effects of spasticity on the spine, hips and legs. Surgery can lengthen or
transfer tendons, enabling the child to move more easily. When the child
has finished growing, bone surgery may help reposition and stabilize the
bones.
Neurosurgery involves surgery on the spines nerve roots, which control
muscle tone. Selective dorsal root rhizotomy aims to reduce spasticity in
the legs by reducing the amount of stimulation that reaches leg muscles

17

via nerves. It can reduce spasticity in some patients, particularly those

who have spastic diplegia. This surgery is irreversible and permanent.
Intrathecal Baclofen Therapy (ITP Pumps) is a surgical procedure
where an ITP Pump is implanted into the abdomen with a catheter leading to the spinal canal.
Adaptive Equipment
An enormous range of aids and adaptive equipment is now available
for people with disabilities. As the number of elderly people in Canada
increases, more daily living aids are coming onto the market.
Mobility devices include:

Wheelchairs (manual, power and sports)

Scooters
Specially made bicycles and tricycles
Walkers and crutches

Communication devices include:

Symbol boards
Voice synthesizers
Head sticks and key guards for
computers
Specialized computer hardware
and software

Daily living aids include:

Electronic door openers

Large-handled eating utensils
Grab sticks
Environmental control systems

Some equipment is available through provincial health and social service

systems. These vary across the country. The Cerebral Palsy Association
can advise you what is available in your area.

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Educational Supports
Many children with CP will also have some type of learning disability.
Assessment by a psychologist, and the support of special educators can
reduce the impairing effects of a learning disability.
Canada has some of the worlds best early intervention programs.
Children with CP will often start their education early to improve their
mobility and communication skills before starting school. The availability
of early intervention programs are often subject to government funding
and trained professionals.
In BC, children with CP receive an integrated education enabling them
to mix with their peers in their neighborhood school. A child with mild
CP may simply require minor program adjustments. For example, he
may need a little more time to write an exam if his hand control is poor.
A child with more severe disabilities may require considerable support
from resource staff and teaching assistants.
Children should have an Individualized Education Plan (IEP), which assesses the childs performance, sets goals and specifies which supports
are required. The amount of support offered, and the commitment to
successful integration, varies widely between school boards and individual schools. A good partnership between parents and educators will help
children to achieve their goals.

Developing a positive attitude is very important, and

although children with disabilities will inevitably
become aware of their limitations, they should always be
encouraged to take on new challenges.
Dr. Mark Nagler, Ph.D.

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Living With CP
Impact on Family
Raising a child with CP can be a challenge for everyone in the family.
Parents love their child deeply and often are prepared to do whatever is
necessary to help their child achieve their potential. They may, however,
still face a mixture of conflicting emotions such as love and anger, hope
and despair, guilt and frustration. Brothers and sisters of a child living
with CP will also be greatly affected. Some children may feel resentful and neglected as their parents spend a great deal of time with their
sibling with a disability. Parents will need to support their able-bodied
children and help them understand and adjust to this new situation.
Raising a child with any disability will mean making changes in the family. Understanding the challenges theyll face, and committing to facing
them together, will provide the family with a strong foundation to stand
on and a secure base of support for all family members.
Growing Up With CP
CP doesnt have to stop children from going
to school, making friends or doing things they
enjoy; however, they may have to do things a
little differently.
People with CP are able to dance, play basketball, ski, cycle, etc. For the child with CP this
can reduce the amount of physical therapy a
child needs and receives. Remember, having
CP does not mean a person is unhealthy.
Interdependent Living

Paul Gauthier
Paralympic gold medalist

People living with CP are usually able to live independently in the community either with or without assistance. Adaptations in the home, such
as stairlifts and grab bars, can be made to make it more user-friendly.
Advanced technology, can help enable people living with CP to be productive, contributing members of society.
CP is not a life-threatening condition, and in itself, is no barrier to leading a long, satisfying life. People with CP enjoy many of the milestones

20

the most people enjoy, including fulfilling careers, a university education, a social life and marriage.
Women with CP are as biologically and physically capable of having children, as they are of caring for and loving them. Arrangements can be
made to make pregnancy and the birthing process safer and easier for
someone with CP. As well, many adaptations can be made around the
home to enable caring for the child easier for parent(s) with CP.
A person living with CP has to cope with both disabilities and barriers. A
disability is a physical loss of function such as walking or difficulty with
hand control or speech. A barrier is the degree to which that disability
puts a person at a disadvantage in daily life; for instance, someone who
is very short-sighted may be considered to have a disability, but she is
unlikely to consider this a barrier if she has corrective lenses. A disability
may prevent someone with CP from climbing stairs, but this will only be
a barrier if the building she wants to enter is not wheelchair accessible.
Loss of function cannot be changed, but barriers can be removed.
Key elements to minimize the barriers experienced include:

Management and Treatment

Accessbeing able to enter and use public buildings, washrooms,
and transportation devices (to name a few)
Attitudesprejudice and teasing can be very damaging to a person
with CP, as can many misconceptions and myths concerning their
abilities and intelligence

It is important to remember that people with disabilities are people first

and share similar needs, desires and drives as the rest of us!

Disability

is a loss of function

Barrier

is the effect of that disability

in daily life

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A Parents Perspective
By Cal Lambeth
My daughter was born nine weeks prematurely after my two-week stay in
hospital with ruptured membranes. She had to be resuscitated in the delivery room. She had no breathing difficulties and was soon transferred
out of the intensive care nursery. Five weeks later, still a month ahead of
schedule, we took her home.
I remember that time as a difficult one of adjustment. She was our
first baby. Things just hadnt gone according to script. I felt both she
and I had been cheated out of those important nine weeks in the womb.
These negative feelings were those of many new mothers and they did
not relate to any anxiety about her long-term health. Rather nave, I had
considered that her birth circumstances were either do or die. She
would be born and survive with no further problems, or she would die
(probably from breathing difficulties). I was unaware of the increased
risk of many disabling conditions which prematurity creates.
Over time I began to notice things about her. She was irritable and
colicky. She couldnt seem to master breast-feeding as her tongue kept
thrusting out. Her head control was very poor. She kept arching her back
to look over her head. For a time we all found this amusing, thinking
that the ceiling fascinated her. Her right hand remained almost always
clenched. Her legs seemed stiff and her feet scissored. Gradually, private
little fears began to creep in, but I held them off as merely relating to her
prematurity.
Because of her premature birth she became involved in a study of
lung maturity. This necessitated follow-up with certain health professionals over the course of the year after her birth and it was as a result of
this study that we received a diagnosis. When she was about 11 months
old, a pediatrician at one of these meetings merely said, Youre aware
that she has Cerebral Palsy. She was described as mild to moderate. I
was absolutely devastated. I remember clutching her and sobbing, My
poor baby! It was like a scene from a bad movie and I still remember
it vividly. Later, doctors apologized for this rather blunt and unprepared announcement. It seemed that they had been concerned about her
condition for some time but were monitoring it and didnt want to say
anything until they were sure of the diagnosis. Although I appreciated
their goodwill, I questioned the withholding of this information. They
couldnt shield me forever and, in my opinion, my daughter was losing
valuable time in which to begin physiotherapy.
Thus began our lives as Parents of a Special Needs Child. Those were
bleak days. I was despondent, panic stricken, and felt that life would never be good again. My career plans were destroyed. Looking back at this
22

time I realize how bitter and hostile I was. I found it difficult to maintain close relationships with people who had children similar in age to
my daughter. I wanted to scream when they complained that their child
was into everything while mine lay flat on the floor, unable to sit or
crawl. I also felt angry when people told me how marvelously I was coping. I felt neither marvelous, nor that I was coping well; furthermore,
it seemed that this was an indication of their view that my child was a
burdenprivately, I felt this way myself at times. I suppose this all represented a fairly typical and predictable process.
Although I presented a bold front to those around me, the truth of
the matter was that I was depressed and frightened. I was fortunate to
have a family, which offered physical help and a listening ear. Not everyone is so lucky. I strongly felt the need to talk to others about their
own experiences. My first thought was to look up Cerebral Palsy in
the telephone directory. I took a deep breath and called the number of
the Cerebral Palsy Association, determined to be strong and in control.
Shortly into the conversation I broke down, but the woman I spoke to
was kind. She offered the information that her husband had CP and that
they were expecting their first child. These words gave me a new sense of
what the future could hold. CP was not a death sentence. My child could
grow up, be happy, and lead a life of purpose. At least the possibility was
there. From this conversation I received information about parent support groups, which I attended for a time and found valuable. But the
most important fact was that I had taken some action. This small step
had helped to allay the sense of aloneness and had given me a renewed
sense of control.
Our family is now much like any otherenjoying the excitement of
new achievements and the ups and downs of child rearing. It would be
wrong to claim that all of the emotional and psychological hurdles have
been overcome. As our child matures new challenges present themselves.
We are always seeking new ways to adapt her physical environment to
allow greater independence. We want to encourage self-esteem, and
pleasure in new achievements. We are not experts in these matters, but
have learned to rely upon our common sense and the knowledge and expertise of those we trust.
A Parents Perspective
By Conrad van der Kamp
Recently I was asked: so whats the special role of a Dad in the life of a
child with CP? Whats the role of a Dad in any childs life? Its all about
providing, safeguarding, teaching, hugging tightly and encouraging.
And its also about encouraging from the sidelines and standing back
23

when your child stumbles. It involves making room and letting go.
Letting go is pretty tricky, especially when the child faces unusual obstacles and a little help would help so much. Do you want a hand with
that sleeve? You want me to cut that sandwich? How about I proofread
that essay? I know you can do that transfer, but its so much faster if I
justand so on. When our daughter was little I would swing her in and
out of cars, into her wheelchair, and into bed. When she got older, I could
still lift her in and out of cars. It was just easier; faster and easier. Well yes,
maybe easier, but maybe not so smart. Not so smart for my back in any
case, but also not smart as a way to affirm the young woman that she had
become. I had to learn, and am still learning, to adapt to her rhythms and
her timing; learning to let her lead.
It was the same with schoolingI wanted to wade in, shape everybody up, and have them really see this soft-spoken plucky girl instead
of the wheelchair. I wanted to guard her from offhand cruelty, from casual inattention, and from well meant but patronizing gestures. At the
same time, I wanted to constrain her to act
normal, talk normal, and to disappear into
the crowd. Well I couldnt accomplish any of
those. In the end I came to acknowledge that
she was pretty good herself at dealing with
all the indignities. She was pretty darn good
at skippering to her goals and awfully darn
good at reading people along the way.
So now I sit at the table in her cheery,
bright apartment, while one of the attendants
she has hired is bustling about. My daughter gives me instructions. Sometime, if you
Tammy van der Kamp
want, Dad, I could use, and pretty soon
Im fixing a loose cupboard door, or maybe Im just digging some bulbs
into her patio border, happy that Im still in the game. I can still fix things
at least a little bit. Then the thought crosses my mind that maybe she figures shes the one helping me by giving me some tasks. I straighten up
and scratch my head for a moment, trying to get used to that idea, and
then I get on with the digging.

24

Aging and CP
No two people, including those with CP, will experience the aging process in quite the same way; however, one thing is certain, like all of us,
they will slow down as they age.

Their energy levels wont be as high as they used to be

They wont be able to accomplish things the ways they used to
They may not remain as independent as they would like to be

People with CP are considered to have a normal life expectancy; however, the physical challenges of CP may intensify with age; for instance,
increased spasticity, fatigue, loss of strength, and declining mobility. In
addition, adults living with CP may deal with many of the usual physical
problems of aging at a much earlier age than people without disabilities.

This person now uses a scooter to

enhance her mobility. A lifetime of
crutch walking has contributed to
an overuse injury to her shoulders.

Further, research indicates that as they age adults with CP are

susceptible to such problems as:

Chronic pain
Physical fatigue
Arthritisbecause of repetitive motions such as pushing
wheelchairs or leaning on canes
Osteoporosiswhich may lead to such secondary complications
as hip fractures
Bowel and bladder problems
Increased respiratory problems
Decreased reproductive and sexual functioning

Like many aging people, those with CP may face greater isolation and
loneliness because of their physical inability to get around as easily as

25

others. Their decreased mobility can sometimes put them at greater risk
for abuse and victimization. This abuse can be physical, financial, sexual
or emotional in nature.
Coping with the Aging Process
A lifestyle that involves regular exercise and proper nutrition is important for everyone, including those with disabilities. Exercise may just
seem like one more thing to fit into a schedule already overwhelmed by
the demands of everyday life: work, school, medical appointments and
social activities. A good general fitness level will help maintain range
of motion and flexibility. Exercise to improve cardiovascular fitness can
also improve endurance and physical strength, thus helping to offset agerelated changes that lead to fatigue.
When dealing with fatigue, people with CP can take steps to make sure
they dont get over-tired. They should realize their limits and take breaks
or rest when feeling tired or in pain.
Methods to lessen pain may include: avoiding physical exertion, taking pain medications such as Diazepam or over-the-counter analgesics
or using interventions such as tendon-release Morphine and Baclofen
pumps. Psychological counselling and biofeedback may also help to reduce pain. People with CP feeling lonely or isolated may also benefit from
participation in leisure activities targeting people with disabilities, from
counselling, or by sharing their feelings with someone they trust.
Everyone needs a proper attitude, knowledge, and skills to make wellinformed decisions concerning their health and well-being. Adults with
disabilities need to learn to take an active role in their personal health
management. It is well known that stresses associated with aging are
lessened if a person is able to maintain a positive personal attitude, is
involved in meaningful activities and has developed a supportive environment. For a person living with CP it is wise to seek information, to
plan for age-related changes, and to be an active participant in his health
care and lifestyle choices.

26

What Research is Being Done on CP?

Research programs across North America are looking for ways to
prevent CP, to reduce its effects, and to improve the quality of life
for people with CP. Research questions being addressed include:

What are the factors that predispose the developing brain to injury?
Can these factors be eliminated or minimized?
How do associated risk factors relate to the severity of CP?
What are the causes of injury to the developing brain? Can the
developing brain be protected? What are the causes of developmental
delays and failure to thrive?
Why is a low birth weight in full-term and premature infants a important risk factor for CP? How do infections, hormonal problems,
etc. increase the chance of a premature birth?
Can CP be diagnosed before birth and/or better diagnosed shortly
after birth? Can current diagnostic aids be improved to give more
accurate results in the diagnosing of CP?
Can the injured brain cells of persons with CP be repaired or
re-grown?
Which treatments are most effective in dealing with the physical
limitations of CP? How effective are existing treatment/management
strategies?
What are the effects of aging on the person with CP?
Based on new developments in the medical, surgical, behavioral, and
bioengineering sciences, what improvements can be made in the
quality of life of people with CP?
What are the social and emotional effects on the child growing up
with CP? How can she be helped to develop a positive self-image?
What obstacles does society create for persons with disabilities
(including CP)? How can these be overcome?

I like to throw a monkey wrench into those preconceived

notions of what a person with a disability can accomplish.
Its fun, and I try not to gloat.
T van der Kamp

27

Web Sites
Web sites change quickly and this information will date. The following
may be good starting points to link you to further information and other
organizations.
www.vcpgv.org
Web site of the Voice of the Cerebal Palsied of Greater Vancouver.
www.cerebralpalsymagazine.com
Web site for the official Cerebral Palsy Magazine printed quarterly every
year, focusing on issues concerning CP.
www.ucp.org
National homepage of United Cerebral Palsy, the leading source of
information and advocacy for people with CP in the United States.
www.ninds.nih.gov
Research information from the National Institute of Neurological
Disorders and Stroke of Maryland.
www.scope.org.uk
Scope, formerly The Spastics Society, is the largest charity working
with people with disabilities in the U.K.
www.aacpdm.org
Web site for The American Academy for Cerebral Palsy and
Developmental Medicine.
www.diversityworld.com
Diversity World offers information and resources concerning
employment issues for persons with disabilities.

28

Your Knowledge Centre

Knowledgeable BC Cerebral Palsy staff are available to answer your

questions about CP, CPA-BC services, and other relevant community
supports.
Our Library contains books and videos concerning Cerebral Palsy
that are useful to parents, professionals and those living with CP.
Through public speaking we work to raise awareness of Cerebral
Palsy and to remove attitudinal barriers experienced by those living
with CP, by providing presentations and workshops to schools,
community groups etc.
Our Website provides general information about Cerebral Palsy and
links you to others both living with CP and those groups serving
those with Cerebral Palsy.
The Roundtable is available to all members of the Association. It
is produced on a quarterly basis and will keep you up-to-date as
to what is going on in the Association and the larger disability
community.
Educational Bursaries: These are awarded to students living with
Cerebral Palsy who are planning to pursue post-secondary education
or attend institutions of higher learning during the following year.

Volunteer Board of Directors2006

29

The Professional Team

Most hospitals, treatment centers and community programs use a team approach
to therapy. The professionals in the team are highly trained in specific aspects of
CP, but you know your child best. If you have a child with CP, he may benefit from
a consultation with some of the following specialists.
Audiologist: Identifies and measures hearing losses and the health of the organs of
hearing. Audiologists can fit and manage
hearing aids, and perform listening tests on
children who have difficulty paying attention.
Dentist: Specializes in the care and treatment of teeth and gums. The spasticity and
feeding difficulties of CP can lead to dental
problems. Children with CP should see a
dentist before or during their fourth year. Try
to see a dentist who is familiar with CP.
Ear, Nose & Throat (ENT) Physician: Can
diagnose and treat problems in hearing,
feeding, swallowing and drooling. ENT
physicians may be consulted about
problems with severe or repeated ear
infections, enlarged tonsils or adenoids.
Also known as otolaryngologists.
Early Childhood Educator (ECE): Translates
recommendations from your childs therapists
into practical, enjoyable, play experiences.
The ECE enables children with CP to attend
regular daycare or pre-school programs.
Kinesiologist: Helps to improve movement
quality and uses specialized athletic and
recreational programs to provide good
experience of the body motion.

Neonatologist: A paediatrician who

specializes in the care of newborn infants.
Neurologist: Specializes in the diagnosis
and treatments of disorders of the nervous
system.
Neurosurgeon: Performs surgery on the
brain, spinal cord and other nervous tissue.
Nutritionist or Dietician: Specializes in
feeding and nutritional needs. Children who
have difficulty feeding may need special
nutritional supplements. A nutritionist may
also recommend a diet to prevent constipation in children with weak abdominal
muscles.
Occupational Therapist (OT): Designs
purposeful activities to help your child
develop fine motor skills and become
independent. They also help clients learn
skills for day-to-day living (such as dressing,
grooming, or cooking), school and work.
OTs may recommend and provide training
in adaptive equipment such as bathroom
aids, seating and mobility systems and
adapted toys. They can advise on wheelchair
accessibility issues at home or school.
Ophthalmologist: A doctor specializing in
disorders of the eye and vision.
Optometrist: Examines, measures and
treats visual defects by means of glasses or
contact lenses.

30

Orthopaedist: A surgeon who specializes in

disease and abnormalities of the locomotor
system (bones, muscles, joints and tendons).
In addition to performing surgery, an orthopaedist can recommend special footwear or
braces. An orthopaedist might also be called
on to predict, diagnose, or treat muscle
problems associated with CP.
Orthotist: Designs specialized mechanical
devices, such as braces and shoe supports to
support or supplement weakened or abnormal
joints or limbs.
Paediatrician: Specializes in the health,
development and diseases of children.
Paediatric Neurologists have expertise in the
diagnosis and treatment of brain disorders,
including epilepsy. Developmental
Paediatricians are experts in the diagnosis
and management of developmental and
behavioral disorders. They examine how a
child is growing or developing in relation to
other children of the same age.
Physiatrist: A doctor specializing in physical medicine and rehabilitation. They help
to restore optimal function to people with
injuries to the muscles, bones, tissues, and
the nervous system.
Physical Therapist (PT): Helps with mobility, strength and physical independence. PTs
focus on gross motor functions, strategies
to reduce spasticity, help children move
correctly, and teach alternate ways of movement such as walkers or wheelchair mobility.
Podiatrist: Diagnoses and treats disorders
and diseases of the foot.

Psychiatrist: A doctor who diagnoses and

treats mental, emotional and behavioral
disorders. They can prescribe medication
whereas a psychologist cannot.
Psychologist: Provides assessment, consultation and interventions for learning,
behaviour, and socializing or emotional adjustment difficulties.
Recreational/Sports Therapist: uses sports
and leisure activities as a form of therapy.
They work with children on such activities
as dancing, swimming, horseback riding, art,
horticulture, and any other hobby the child
is interested in.
Rehabilitation Engineer and Technologist:
Brings knowledge of modem technology to
the design, construction and maintenance
of adaptive devices including wheelchairs,
augmentative communication devices, and
environmental control aids.
Social Worker: Provides supportive counselling and referral services to assist families
in coping with the additional challenges of
raising a child with a disability.
Speech-Language Pathologist: Helps
children to develop their verbal communication. Can recommend and provide training
in the use of augmentative communication
equipment, and can assist with chewing and
swallowing difficulties. Also called a speech
therapist.
Urologist: A specialist in diseases of the
urinary organs in females and the urinary
tract and sex organs in males. Also called a
urological surgeon.

31

Glossary
Analgesic: A medication that reduces or
eliminates pain.
Anesthetic: A medication that causes
temporary loss of bodily sensations.
Apgar score: A system of evaluating a
newborns physical condition by assigning a
value (0, 1, or 2) to each of five criteria: heart
rate, respiratory effort, muscle tone,
response to stimuli, and skin color.

Diabetes: Any of several metabolic disorders

marked by excessive urination and persistent
thirst.
Dysarthria: Problems with speaking caused
by difficulty moving or coordinating the
muscles needed for speech.
Electroencephalogram (EEG): A technique
for recording the pattern of electrical
currents inside the brain.

Arthritis: Inflammation of a joint or joints

resulting in pain and swelling.

Electromyography: A special recording

technique that detects muscle activity.

Asphyxia: Lack of oxygen due to trouble

with breathing or poor oxygen supply in the
air.

Epilepsy: A disorder of the central nervous

system characterized by loss of consciousness and convulsions.

Baclofen: A medication that acts as a muscle

relaxant and is used to treat spasticity.

Failure to thrive: A condition characterized

by lag in physical growth and development.

Basal ganglia: The part of the brain

responsible for gross motor functioning.

Fine motor skills: Control over actions that

have to do with smaller movements such as
reaching and grasping.

Biofeedback: A technique of becoming

aware of involuntary bodily processes (such
as heartbeat or brainwaves) in order to
consciously control them.
Cerebellum: The part of the brain
responsible for the regulation and
coordination of complex voluntary muscular
movement as well as the maintenance of
posture and balance.
Cerebral: Relating to the two hemispheres
of the human brain.
Computerized axial tomography (CAT): An
imaging technique that uses X rays and a
computer to create a picture of the brains
tissues and structures.
Congenital: Present at birth.
Contracture: A condition in which muscles
become fixed in a rigid, abnormal position
causing distortion or deformity.

32

Gait analysis: A technique that uses camera

recording, force plates, electromyography,
and computer analysis to objectively
measure an individuals pattern of walking.
Gross motor skills: Control over actions that
help children get around in the environment,
such as crawling, standing and walking.
Hemiparetic tremors: Uncontrollable
shaking affecting the limbs on the spastic
side of the body in those who have spastic
hemiplegia.
Hyperthyroidism: Overactive thyroid gland
resulting in an increased metabolic rate, an
enlargement of the thyroid gland, rapid heart
rate, and high blood pressure.
Hypertonia: Increased tone/extreme
tension of muscles.

Hypotonia: Decreased tone/reduced

tension of muscles.
Hypoxic-ischemic encephalopathy: Brain
damage caused by poor blood flow or
insufficient oxygen supply to the brain.
Jaundice: A blood disorder caused by the
abnormal buildup of bile pigments in the
bloodstream.
Magnetic Resonance Imaging (MRI): An
imaging technique which uses radio waves,
magnetic fields, and computer analysis to
create a picture of body tissues and
structures.
Motor cortex: Part of the brain responsible
for movements of the face, neck and trunk,
and arm and leg.
Neonatal hemorrhage: Bleeding of brain
blood vessels in a newborn.
Orthotic devices: Special devices, such as
splints or braces, used to treat problems of
the muscles, ligaments, or bones of the
skeletal system.
Osteoporosis: A disease in which the bones
become extremely porous (holes), are
subject to fracture (break), and heal slowly.
Paresis or plegia: Weakness or paralysis. In
Cerebral Palsy, these terms are typically
combined with another phrase that
describes the distribution of paralysis and
weakness, e.g., paraparesis.
Palsy: Paralysis, or problems in the control
of voluntary movement.

Rh incompatibility: A blood condition in

which antibodies in a pregnant womans
blood can attack fetal blood cells, impairing
the fetuss supply of oxygen and nutrients.
Rubella or German measles: A viral
infection that can damage the nervous
system in the developing fetus.
Seizure: A sudden attack, spasm, or
convulsion.
Selective dorsal root rhizotomy: A surgical
procedure in which selected nerves are
severed to reduce spasticity in the legs.
Spastic diplegia: A form of Cerebral Palsy in
which both arms and both legs are affected,
the legs being more severely affected.
Spastic hemiplegia (or hemiparesis): A
form of Cerebral Palsy in which spasticity
affects the arm and leg on one side of the
body.
Spastic paraplegia (or paraparesis): A
form of Cerebral Palsy in which spasticity
affects both legs but the arms are relatively
or completely spared.
Spastic quadriplegia (or quadriparesis): A
form of Cerebral Palsy in which all four limbs
are affected equally.
Strabismus: Misalignment of the eyes.
Ultrasonography: A technique that uses
the reflections of high-frequency sound
waves to construct an image of a body
organ (a sonogram); commonly used to
observe fetal growth.

Phototherapy: The treatment of a disorder,

especially of the skin, by exposure to light,
including ultraviolet and infrared radiation.
Reflexes: Movements that the body makes
automatically in response to a specific cue.

33

CP Associations in Canada
British Columbia

Cerebral Palsy Association of Manitoba

105500 Portage Ave.
Winnipeg, MB R3C 3X1

Tel: 604.408.9484
Fax: 604.408.9489
Toll Free: 1.800.663.0004

Tel: 204.982.4842

E-mail: info@bccerebralpalsy.com
www.bccerebralpalsy.com

Alberta

Cerebral Palsy Association in Alberta

Jim & Pearl Burns Centre
3688 48 Avenue NE
Calgary, AB T3J 5C8
Tel: 403.543.1161
Fax: 403.543.1168
Toll Free: 1.800.363.2807
E-mail:admin@cpalberta.com
www.cpalberta.com

Saskatchewan

Saskatchewan Cerebral Palsy

Association
2310 Louise Avenue
Saskatoon, SA S7J 2C7
Tel: 306.955.7272
Fax: 306.373.2665
E-mail: saskcpa@shaw.ca
http://members.shaw.ca/saskcpa/

34

Manitoba

Cerebral Palsy Association of B.C.

801409 Granville Street
Vancouver, BC V6C 1T2

E-mail: office@cerebralpalsy.mb.ca
www.cerebralpalsy.mb.ca

Ontario

Ontario Federation for Cerebral Palsy

1630 Lawrence Ave West, Suite 104
Toronto, ON M6L 1C5
Tel: 416.244.9686
Fax: 416.244.6543
E-mail: info@ofcp.on.ca
www.ofcp.on.ca

Qubec

Association de Paralysie Crbrale

de Qubec
988 Galt west
C.P. 1781
Sherbrooke, PQ J1H 5N8
Tel: 819.829.1144
Fax: 819.829.1121
E-mail: info@paralysiecerebrale.com
www.paralysiecerebrale.com

New Brunswick

Cerebral Palsy Foundation (St. John)

P.O. Box 2152
Saint John, NB E2L 3V1
Tel: 506.648.0322
E-mail: mail@cpfsj.ca
www.cpfsj.ca/

Nova Scotia

Halifax Regional Cerebral Palsy

P.O. Box 33075
Quinpool Postal Outlet
Halifax, NS B3L 4T6
Tel: 902.479.0963
Fax: 902.423.4340
E-mail: cerebral.palsy@ns.sympatico.ca
www.hrcpa.ca/

Prince Edward Island

P.E.I. Cerebral Palsy Association

P.O. Box 22034, 13 Linden Ave
Charlottetown, PEI C1A 9J2
Tel: 902.892.9694
Fax: 902.628.8751

Newfoundland

Cerebral Palsy Association

of Newfoundland
P.O. Box 23059
Churchill Park Postal Outlet
St. Johns, NL A1B 4R9
Tel: 709.753.9922
E-mail: cerebralpalsy@nf.aibn.com
www.cpnl.ca/

35

36

bccerebralpalsy.com

Cerebral Palsy Association of British Columbia

801 4 09 Granville Street
Vancouver, BC V6C 1T2
t: 604.408.9484 toll free: 1.800.663.0004 f: 604.408.9489
e: info@bccerebralpalsy.com