Therapeutic Listening & Cerebral Palsy

 

Clinical Note: Many individuals with the diagnosis of cerebral palsy also have sensory integration issues that can impact their motor control. Therapeutic Listening can be helpful for this.

 

Abby

   

Abby was a seven-year-old girl with a diagnosis of mild cerebral palsy and strabismus at the time of evaluation. She had been adopted from a Ukrainian orphanage at three years of age. Although having cerebral palsy created a variety of motor difficulties, Abby’s parents were particularly concerned with her fear of activates that required balance. She avoided playground structures and was fearful when walking up or down stairs or over uneven surfaces such as her backyard. Even when she was holding on to an adult or stationary object, she expressed great fear of these movements.

 

Abby struggled with the ability to modulate sensory input and self-regulate. She had poor control of regulatory functions, which were likely complicated by her neuromotor condition. She did not have any nighttime bladder control and had frequent daytime bladder accidents. Although Abby was able to fall asleep without difficulty, she was a restless sleeper and would often be found in odd sleeping positions during the night. In addition, her poor self-regulation led to frequent tantrums, which could be triggered by a simple request to clean her room or pick up her toys. These tantrums usually lasted 15-20 minutes.

 

Abby had an incessant need to touch or mouth objects and often chewed on ties of her clothing, doll hair, or plastic toy pieces. Abby also had mild tactile defensiveness and could not tolerate being barefoot.

 

It was difficult for Abby to complete daily tasks such as eating, dressing, and picking up her toys in a timely manner. She was somewhat disorganized in her approach to these tasks. Also, she was easily distracted and had difficulty tuning out background noise. The distractibility made it challenging for her to do seated task work both at home and school, and also impacted her ability to transition between activities. She repeatedly forgot what she was supposed to be doing and needed verbal cues to move to a new task. At mealtimes, she was often so distracted by the items on the table or by playing with her food that it could take over 30 minutes to eat a meal. After her bath, Abby would become distracted by the toys in her room and forget to start her dressing routine. If not given repeated verbal reminders, she could be distracted for 20-30 minutes before transitioning back to her original task.

 

Abby’s poor body scheme and lack of spatial awareness impacted her dressing, handwriting, and ability to maneuver through her environment. Abby struggled with putting clothes on and finding objects in her room. Even after demonstration, she put clothing on backwards and often could not find clothing items in her drawers. Abby struggled not with the formation of letters, but with the ability to spatially place them on a page. Abby was accident prone and often bumped into objects while trying to navigate within a space. This was true for familiar environments as well as unfamiliar environments. She was also fearful of putting her head under water at the swimming pool, which may have indicated a discomfort with the changes to the spatial environment.

 

Abby’s underdeveloped movement patterns restricted her ability to interact with people and objects. She struggled with motor skills such as hopping, jumping, skipping, and running, and she fatigued quickly during these activities. Abby also had difficulty assuming and maintaining antigravity flexion and extension postures. She was unable to separate eye movements from head movements, and often used whole body movements instead of rotating at the head/neck, shoulders, or trunk.

 

 

After Therapeutic Listening

 

With the start of a Therapeutic Listening program, Abby made good progress in her motor skills, spatial awareness, postural control, self-confidence, and overall regulation. While at times she had fluctuations in bladder control, sleep, and mood, this is often a part of the process of learning to regulate and usually resolve over time.

 

Staying dry overnight had been a longtime struggle for Abby. She began staying dry more often soon after starting her listening program. The longest she used to be able to go without a wet pull-up in the morning was two or three nights. However, at the time her mother reported, she had thirteen consecutive dry nights.

 

Listening also created a shift in Abby’s overall attitude. Her tantrums diminished, and when she did have a tantrum, she was able to calm herself and recover within a few minutes. Her parents reported that she was generally on a “fairly even keel.” Even out of town friends who saw her infrequently commented that she seemed unusually clam.

 

Abby became increasingly more cooperative and helpful. She began playing with her little sister—even comforting her when she was upset. In addition, she regularly put on her music and headphones independently and began doing her homework without complaint.

 

Abby became more organized and better able to care for her belongings. For example, she organized her clothes in her dresser and her DVD collection for the first time. She also began keeping her toys and drawing supplies organized and even initiated cleaning up on her own.

 

Movement and motor skills improved dramatically for Abby, along with her increased self-confidence with both swimming and walking. She began swimming underwater at the shallow end of the pool. Additionally, the school physical therapist noted that she had better coordination on the BOSU ball and that her jumping skills on a small trampoline were improving; she was showing better coordination and landing with bent knees. Her balance continued to improve, and she was able to spin a full turn on one foot. Her mother reported that she had walked all around a park wearing flip-flops.

 

Her aunt noticed that when she held Abby’s hand, she no longer used it for balance and strength as they walked. When the family was camping, Abby insisted on walking to the bathroom by herself. Additionally, for the first time ever, she was able to jump from the bottom step onto the floor without holding something to stabilize herself. She began seeking out opportunities for running, climbing, and jumping. Her coordination on the swings was also improving; she pumped more strongly and more rhythmically. She also enjoyed climbing on the play structures at the park that had previously been too challenging for her.

 

Abby’s fine motor skilled similarly improved. She was able to write longer paragraphs, was sequencing stories, and began attempting to spell words on her. She also had more even pressure and increased line control when coloring. Additionally, Abby’s parents reported that she had better attention and fine motor skill when she was working with her Lite Brite.