Cerebral Palsy and Children with Vision and Hearing Loss

By Stacy Shafer, Early Childhood Specialist & Kate Moss, Family Support Specialist, TSBVI, Outreach

Hearing Loss and Language Problems

"Robinson (1983) noted that 20% of children with cerebral palsy display hearing or language problems." (Anthony, T. 1993) Typically the hearing loss is sensorineural. Beyond that, not much research has been done to date on hearing loss and CP. It is important, however, that children with

CP also have their hearing assessed, especially if they also have a visual impairment.

Children with CP often have speech problems. This happens because the muscles that are used in producing speech (in the tongue, throat, lungs, etc.) are impacted by the CP, a condition known as dysarthria. Their speech may be slow and slurred. Their voices may have a very nasal quality (hypernasal) if too much air comes through the nose or sound like they have a bad cold if too little air comes through the nose (hyponasal). The child's facial features may also seem distorted when they are speaking. A speech therapist should be consulted to determine if a therapeutic approach might help the child with these problems.

Many people consider using voice output devices with individuals who have CP. Before making such a recommendation, it is important to thoroughly evaluate the child's hearing. His ability to use such a device will be impacted by how well he hears. He may also have problems hearing what the teacher says, participating in group discussions, or any other tasks that requires the use of hearing. If hearing and vision losses are both present, an educational approach for deafblindness should be used.

Learning Problems

Other problems that may impact learning for some children with CP include learning disabilities, mental retardation, and seizures. Good assessment should insure that these issues are appropriately addressed in developing the IEP and providing the necessary adaptations, modifications and related services the child needs to be successful.

Benefits of a Team Approach

It is critical that everyone who works with the child share information and ask questions. The parent, teachers of the visually impaired and hearing impaired, occupational and physical therapists, assistive technology specialist, orientation and mobility specialist, ophthalmologist and audiologist, classroom teacher and others have vital information that is necessary to consider when building a successful program for the child. When the team is designing activities for the child to participate in at home or at school, here are some of questions you might want to ask each other:

• What does the child like to do?
• Are there activities that pose problems because the child doesn't seem to pay attention (i.e., shift gaze, focus on person or object, tracking, use good eye-hand coordination)? What are these activities?
• Which position(s) is best for visual activities? Auditory activities? Hand-eye activities?
• How do I get the child into each of these positions? What tips do you have for getting the child into these positions without hurting the child or the adult?
• What positions place high energy demands on the child?
• What positions make it difficult for the child to use her vision? Hearing?
• What other types of activities can she do in those positions?
• Will the child need any special equipment for positioning in various activities?
• Will the child's hearing aid be adequate for the activity or should other devices such as an FM system be considered? Are any low vision devices needed for the activity? What about augmentative communication devices?
• How will his hearing aid and/or low vision devices interface with adaptive equipment and augmentative communication devices?