What is cognitive functioning?

Cerebral palsy (CP) is much more than a ‘‘disorder of posture and movements’’ and is often associated with a wide range of impairments, including cognitive, linguistic, communicative and sensory-perceptual disturbances.¹   

Cognition is the ability to use one’s intellectual capacity to reason, accurately perceive, and learn. It’s the basis of our ability to use what we know to achieve goals, communicate with others, and build relationships.²

Some level of cognitive impairment is seen in about 30%-50% of children; whereas children with severe CP have a greater likelihood of having the impairments. Some of the brain’s functions that fall under cognition include attention span, comprehension, decision-making, difficulty processing emotions and feelings, language skills, learning, memory, problem-solving, recognition, and speech proficiency.²

According to many studies, individuals with CP and struggling with cognitive impairment have more general health concerns, and a higher mortality rate. Parents worry that their child’s full potential may not be realized, once they learn that their child is cognitively impaired.²

Cognition is the ability of a person to think matters out by using information from the brain. Some of the brain’s functions that fall under cognition include²:

•  Attention span
• Comprehension
• Decision-making
•  Difficulty processing emotions and feelings
•   Language skills
• Learning
• Memory
•  Problem-solving
• Recognition
• Speech proficiency

What causes cognitive impairment?

The motor impairments of children with CP, caused by an inborn or early acquired brain lesion are often accompanied by impaired functioning in cognition.³ The extent and the nature of the impairment depends on the location of the brain injury, and its severity.²

Some of the conditions or circumstances that causes cognitive impairments include brain hemorrhage, chromosomal abnormalities, congenital hypothyroidism, genetic abnormalities, lack of oxygen during labor, prenatal infections, preterm complications, and stroke.⁴

Cognitive impairments can occur at different times and under different circumstances over a lifetime (e.g., Alzheimer’s disease), however, children with CP who have a cognitive impairment are likely born with the condition.²

What are the signs of cognitive struggle?

A child’s cognitive impairment is sometimes difficult to detect. Normally, when a child fails to meet established developmental benchmarks, parents realize that something is different about their child. Still, the signs that a child has a cognitive impairment might be attributed to other factors.²

Some of the signs that a child has a cognitive/psychologic/behavioral impairment include⁴:

·         Mental retardation, most commonly associated with spastic quadriplegia

·         Attention-deficit/hyperactivity disorder

·         Learning disabilities

·         Impact on academic performance and self-esteem

·         Increased prevalence of depression

·         Sensory integration difficulties

·         Increased prevalence of pervasive developmental disorder or autism associated with concurrent diagnosis of CP

It’s important for parents to recognize the signs as soon as possible so they can start working with physicians and therapists on early intervention therapies.²

What are the therapies available?

Early interventions help a child learn to expand his or abilities. The goal is to help a child compensate for the impairments. Some of the barriers that children will address in a school or therapeutic setting include²:

Behavior

Children may experience anxiety, anger, emotional outbursts, and other behavioral issues.⁵ Educators and therapists should encourage interaction between students, by offering recognition, fostering interests in educational and recreational activities, providing assistance in the classroom, and helping them to focus on their successes.²

Communication

Children have trouble talking and expressing how they feel. In school, a child may understand the lesson, but may not be able to communicate the answers correctly. Similarly, at home, the child may not be able to say what’s bothering them, or express how they feel.⁵ Generally, use of photos as visual instructions along with words so children can begin to associate images and words. Also, using simple, short statements would be easy to understand.²

Functionality

A child may not understand how his or her body works, or may have difficulties with spasticity or other physical impairments. Therapists should break down tasks into simple, step-by-step components. A child is then able to process how to handle simple tasks in succession, which lead to the completion of a more complex task.²

Learning

Children may face difficulties with learning and catching up as fast as their peers are.⁵ Visual indications along with speech would help a student understand instructions and commands. Decision-making skills are cultivated by offering students choices and alternatives that help a child to sort out and understand concepts.²

Literacy

Children may not read like other children, but it doesn’t mean they are incapable of understanding what words mean. Educators and therapists will read questions and engage in conversation with the children and their classmates. Visual cards with images on them in cases where a child cannot understand words. This is followed by demonstrations of how the object in the picture is used.²

Memory

Attention deficit disorder, autism, and other disorders may arise, which results in a short attention span and difficulty staying on task. Some may focus only on things that they find interesting, while others may concentrate for a few minutes before becoming bored and zoning out.⁵ Audio playbacks, prompt cards that features objects and keywords, and notes to remind children of what they have learned are some of the methods would help children memorize the lessons.²

Sensory

Children are unable to understand signals from the physical environment. This makes it difficult for the child to adjust to and feel comfortable in different surroundings.⁵ By making sure that clear acoustics are used, which are not too loud or soft, proper aids can be provided to children with low vision, by making sure objects have textures that children can identify, and by using abundant lighting a child’s ability to interpret his or her surroundings can be improved.²

Although there is no cure for cognitive impairment, a number of cognitive interventions have been proven beneficial to children with CP, and any child who experiences cognitive delays.⁵ Setting achievable goals and using correct set of supports would help children with CP overcome cognitive challenges and gradually increase their cognitive abilities.²

References:

1. Fluss J, Lidzba K. Cognitive and academic profiles in children with cerebral palsy: A narrative review. Ann Phys Rehabil Med. 2020 Feb 19:S1877-0657(20)30036-1.
2. Cognitive Impairment [Internet]. Available at: https://www.cerebralpalsy.org/information/cognition. Accessed on Feb 11, 2021.
3. Stadskleiv K. Cognitive functioning in children with cerebral palsy. Dev Med Child Neurol. 2020 Mar;62(3):283–89.
4. Abdel-Hamid HZ. Cerebral palsy [Internet] [Updated Aug 22, 2018]. Available at: https://emedicine.medscape.com/article/1179555-overview. Accessed on Mar 13, 2021.
5. Cerebral Palsy Cognitive Issues [Internet].
Available at: https://www.cerebralpalsyguidance.com/cerebral-palsy/associated-disorders/cognitive-issues/. Accessed on Mar 13, 2021.

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