Introduction and Purpose Cerebral Palsy (CP) is a congenital non-progressive motor
disorder caused by a brain lesion that occurs in the early stages of development and
persists throughout adulthood. CP is one of the most common disabilities in childhood,
with a prevalence of 3.3 per 1,000 children in the United States. It is noted that
"children with disabilities have a greater risk of poor or sub-optimal development in
early childhood compared to children without disabilities". Due to the nature of CP, the
child and their families can experience many limitations in their day-to-day lives and
how they participate in their environment. Many of these limitations are brought to light
when the child is ready to enter school. It is essential that children with CP and their
families understand their child's strengths and areas of need in order to ensure that
their child is offered the requisite support services that adequately prepare them for
school enrolment. The purpose of this study is to determine if an intensive school
readiness program for children with unilateral cerebral palsy (UCP), is feasible and
acceptable, and to gain an understanding of the impact of the program on school
readiness.
Background "School readiness is a framework for assessing the strengths and
vulnerabilities of a child prior to school". Preschool-age children with CP perform
significantly lower than their typically developing peers in the areas of mobility,
self-care, social function, and communication. Because school readiness is lower in
children with disabilities, underachievement and lack of social-emotional skills can
further affect how the child develops into adulthood and possibly change the course of
their lives. There is very little research regarding school readiness programs
specifically for children with cerebral palsy, but other programs that promote school
readiness for children on a universal level have shown to be effective.
The school readiness framework can be used to assess a child's strengths and weaknesses
in the context of transitioning to entering school. School readiness is the child's
ability to participate in 5 major skill areas: (1) health and physical development, (2)
emotional well-being and social competence, (3) approaches to learning, (4) communication
skills, and (5) cognitive skills and general knowledge. Research indicates children with
disabilities encounter challenges in the school setting secondary to poor teacher
training, lack of support, decreased social experience, and physical barriers.
Understanding the areas that children with CP have deficits in and how we can intervene
at an early age can help reduce poor academic performance as the child ages. Studies have
shown that providing a school readiness program to any child, typically developing or
not, not only increases success in the classroom but can also be an investment in the
community's future. School readiness programs can have a positive impact on the community
for up to 60 years or more due to increased success of children at an early age carrying
on into adulthood. Therefore, there is a need to develop and test a school readiness
program that (1) identifies the strengths and areas in need of intervention, (2) educates
caregivers on their child's strengths/needs and available resources, and (3) provides
intensive therapeutic intervention aimed to address the individual school readiness goals
of the child.
Intervention The School Readiness Program is a 64 hour intensive therapy program focused
on school readiness skills for young children with unilateral cerebral palsy (UCP). The
program will include 64 hours of intervention supporting development and goal attainment
across 5 school readiness domains: (1) health and physical development, (2) emotional
well-being and social competence, (3) approaches to learning, (4) communication skills,
and (5) cognitive skills and general knowledge.
Participants will complete 64 hours of intervention focused on school readiness. Each
participant will have an interventionist who is an allied health student with a ratio of
1 child to 1 interventionist or 2 children to 1 interventionist. The interventionists
will be trained and overseen by licensed occupational therapists. Each week will have a
theme to promote engagement and motivation to participate (i.e. animals, outer space,
etc). Each of the five domains will be addressed in each session, and the activities will
be tailored to support the individual goals of the participant using a goal-directed
training approach. A goal-directed training approach includes the child, caregiver, and
researcher collaboratively setting goals that are meaningful to the child and their
family. Intervention strategies for goal attainment will include both remediation of
skills (i.e. learning to button a button) or the accommodation of skills (i.e. using
Velcro instead of a button) depending on the child's goals and current ability. The
primary focus of the intervention will be goal attainment related to school readiness.
Sessions that are missed due to unexpected or unplanned circumstances (illness, loss of
transportation, etc) can be made up via an in-person or virtual session.
Caregivers will be educated on their child's diagnosis, the components of the program,
and additional resources that support the child's transition into school. Caregivers will
also receive a report including a summary of strengths and areas that are challenging for
the child. The goal of the School Readiness program is for children with UCP to increase
independence in school readiness activities and to educate the child's caregiver on
topics and strategies that will promote a successful transition into school for the
child.