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All About Cerebral Palsy

Posted on December 28, 2018 by Ann

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About Cerebral Palsy

What is Cerebral Palsy?

Cerebral palsy (CP) is a neurological disorder caused by permanent non-progressive damage or abnormal development of the brain. The damage may occur before birth, during birth, or during the first year of a child’s life. This means that CP is non-reversible and will not worsen over time.

The brain controls movement, thoughts, memory, speech, and the function of other organs in the body. CP mainly affects areas of the brain that control movement, which causes motor impairments such as: muscle weakness, muscle tightness, difficulties in controlling movement, and abnormal posture. These impairments may have an impact on a child’s ability to function in daily activities.

The effect of CP on a child’s life ranges in severity. The part of the body affected may also vary. Some cases affect only one side of the body, or the lower half of the body, while others affect all four limbs. Children with CP often have other symptoms that accompany the motor abnormalities, these include: seizures, impaired hearing or vision, pain, and issues with bladder and bowel control.

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How Common is Cerebral Palsy?

CP is the most common physical disability in children worldwide. It is estimated that 1 in 500 newborns in the world have CP. Most cases are diagnosed between ages 18 and 24 months, though some cases are detected earlier.

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How is Cerebral Palsy Diagnosed?

The symptoms of cerebral palsy are not usually evident right after a baby is born. They become more noticeable as the child grows and develops. Typically, the first signs of CP are severe developmental delays and problems with movement. A doctor would obtain an extensive history of the child’s birth and run tests to identify the cause of the symptoms. A scan of the child’s brain may be done to locate the area that has suffered damage and confirm the diagnosis of CP.

Types of brain imaging that may be used:

  • Magnetic resonance imaging (MRI): A scanner that uses a large magnet and radio waves to produce a detailed image of the brain.
  • Computed tomography (CT): A scanner that takes several X-ray pictures of the brain at different angles to create a detailed image of the brain.

There is currently no way of detecting CP during pregnancy.

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What Causes Cerebral Palsy?

The exact cause of CP is not clear. However, it is thought to be due to brain damage or abnormal brain development which occurs before, during or shortly after birth. Possible causes of brain damage are:

  1. Before birth: Infections – like rubella, cytomegalovius, or toxoplasmosis – caught by the mother during pregnancy.
  2. During birth: A lack of oxygen or physical trauma due to a difficult birth.
  3. After birth: Infections of the brain or a brain injury.

There are several factors that increases a child’s risk of having CP:

  • Premature birth, especially in babies born before 28 weeks of pregnancy
  • Low birth weight
  • Twin or multiple births
  • Breech presentation (During birth, the baby’s legs come out first before the head)
  • Seizures at birth or shortly after birth
  • Mothers who have health issues during pregnancy such as excessive bleeding, proteinuria (high levels of protein in their urine), thyroid disease, seizures

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Symptoms of Cerebral Palsy

The symptoms of CP vary from child to child. It depends on the severity of brain damage and parts of the body that are affected. These are some of the most common symptoms of CP:

  • Delays in reaching developmental milestones (such as not sitting by eight months or not walking by 18 months)
  • Poor feeding during infancy
  • Poor control of head (like difficulties turning head, or holding head upright when sitting)
  • Arms or legs seem too stiff (Hypertonia)
  • Weak arms or legs (Hypotonia)
  • Fidgety, jerky or clumsy movements
  • Random, uncontrolled movements
  • Shaking hands (tremors)
  • Walking on tiptoes

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Classification of Cerebral Palsy

There are several ways to classify cerebral palsy and its symptoms, which are according to the parts of the body affected and the severity of the effects.

As the child grows older, his/her symptoms usually point to a specific subtype of cerebral palsy.

CP SubtypesSpasticDyskineticAtaxic
FeaturesMuscles are stiff and tightInvoluntary movements like abnormal postures or repetitive movements occur when moving limbsLack of coordination of movements
Limited movement of the affected limbsMuscle spasmsMovements are unsteady, shaky, clumsy, or jerky
Muscle weakness (Hypotonia)
Language skills are typically delayed
Effects on armsFingers are fistedDifficulties holding objectsShaky movements
Wrist is bentInaccurate movements as a result of trying to control the unsteady movements
Elbow is bentDifficulties in performing tasks that require repetition (clapping) or precise finger movements (writing)
Effects on legsLegs tend to be pulled together at the knees and cross like scissorsDifficulties standing and walking due to involuntary movementsPoor balance: May fall without reason or when walking on uneven surfaces, or unable to regain balance when bumped into by another person
Ankle is bent with toes pointed downwards and inwardsWide-base gait: Walks with feet spread further apart than the hips when walking to compensate for instability and poor balance

CP may cause damage to different areas of the brain, which control different parts of the body. Three common ways the body is affected are classified as follows:

  • Diplegia: Both legs are affected. Both arms may be slightly affected.
  • Hemiplegia: The arm and leg of one side of the body are affected.
  • Quadriplegia: Both arms and legs are affected. Muscles of the face and body may also be affected.

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Physical and Medical Issues that May Accompany Cerebral Palsy

Aside from motor impairments, children with CP may also have a range of other problems that depend on the severity of the brain injury. Not all children with CP may have these issues, though some of them have a higher risk than others.

Eye Problems

  • Some children may have reduced vision, an eye with a squint, or uncontrollable eye movements

Ear Problems

  • Impaired hearing or hearing loss

Feeding Problems

  • Difficulties sucking, chewing, or swallowing
  • Uncontrollable drooling due to difficulties with swallowing or with lip closure
  • Feeding issues may result in poor nutritional status. A doctor may suggest the use of a nasogastric tube (feeding tube inserted through the nose to the stomach) or a gastrotomy tube (feeding tube is inserted surgically through the abdomen into the stomach) for feeding to improve the child’s nutritional status.

Digestive Issues

  • Acid reflux of the stomach, where acid from the stomach travels up into the throat. It is also known as gastro-oesophageal reflux disease (GORD).
  • Difficulties with bowel movement which may result in constipation

Respiratory Problems

  • Weakness or poor coordination of muscles used for breathing may result in ineffective breathing and difficulties in clearing secretions from the lungs

Speech Impairment

  • Difficulties with producing speech when muscles in the throat and mouth are affected

Spinal Deformity

  • Children with CP are prone to the development of an abnormally curved spine (scoliosis). It is very treatable when detected at an early stage.

Hip Displacement

  • Children with spastic CP have a risk of having hips that pop out of the joint easily

Osteopenia (Weakened bones)

  • Children with CP may have weakened bones that can result in frequent fracture
  • May be caused by lack of movement, poor nutrition, and the use of antiepileptic drugs

Neurological Problems

  • Epilepsy (seizures or fits) is common in children with CP. The first occurrence of epilepsy typically happens during the first two years of life.

Sleep Disorders

  • Children with CP have high rates of sleep disorders which may be due to an abnormal sleep-wake cycle, pain, or difficulties breathing

Chronic Pain

  • May be due to muscle tightness, hip dislocation, constipation, or other causes
  • Sometimes it is difficult for children with communication difficulties to express their pain

Intellectual Disability

  • Approximately half of children with CP have an Intellectual Disability (ID). The severity of ID is correlated with the extent of the child’s physical disability and varies substantially.

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Health, Treatment and Therapy

 

While cerebral palsy cannot be cured, early treatment will often improve a child’s ability to participate in daily activities. In general, early intervention encompasses therapy, assistive devices, medication, nutrition, and educating parents on how to care for and your child with special needs.

Cerebral palsy is a permanent non-degenerative disorder. Once a part of the brain is damaged, the affected cells are destroyed. Since brain cells cannot regenerate, the area affected is permanently damaged. Though there is no single solution to brain damage, the symptoms of CP may be managed through various medical and therapeutic methods.

The treatment of CP requires a multidisciplinary approach with the involvement of you and your family, doctors, therapists, and teachers. This ensures that all areas of your child’s well-being are addressed. The treatment of your child may be divided into:

  • Non-medical treatment: Therapy, Nutrition, Assistive Technology Devices
  • Medical treatment

Generally, non-medical treatment would be the first step in managing your child’s primary symptoms. If his/her symptoms cannot be controlled then your child’s doctor may recommend medical treatment like drugs or surgery.

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Therapy

Therapists are health professionals that are equipped with skills in working with children and teaching parents effective ways to help their children. During therapy, a therapist would assess your child’s abilities and needs, and provide treatment and advice. Your child will learn to acquire skills needed for independent living, while you will learn how to support and encourage your child’s development.

Therapies that may help your child:

  1. Physiotherapy

Physiotherapists are involved in helping with movement and pain. Some of the ways physiotherapists may help your child:

  • Teach you the correct methods of carrying and positioning your child so as to prevent excessive strain on yourself and avoid placing your child in awkward postures
  • Exercises to prevent/reduce muscle tightness and to improve muscle strength
  • Advise and prescribe equipment that will serve the needs of your child like wheelchairs, walking aids (such as walking frames or crutches) and orthotics (such as braces and splints)
  • Facilitate motor development of your child (such as sitting, crawling, walking)
  1. Occupational Therapy

Occupational Therapy is concerned with your child’s daily activities. This includes bathing, feeding, dressing, play, and education. As your child grows older, Occupational therapists (OTs) will help your child become more independent in caring for themselves using assistive devices or by simplifying activities. OTs may help by:

  • Teaching you easier ways of bathing, feeding, and dressing your child
  • Facilitate your child’s development through play and sensory stimulation
  • Suggesting the use of assistive devices for your child to carry out his/her daily activities
  • Teaching your child skills needed to attend school (like handwriting and using scissors).
  1. Speech Therapy

Speech therapy focuses on the assessment and management of speech, communication, feeding and swallowing difficulties. If your child has difficulties with speech and communication, a speech and language pathologist (SLP) will find ways to encourage your child’s speech and language development. Sometimes your child requires an alternative means of communicating (like using hand signals or a communication book), and the SLP will identify the best way for your child to communicate. If your child has issues with eating and drinking, the SLP will help with improving your child’s control of the muscles of the face, mouth, and throat.

  1. Therapeutic Horse Riding and Hippotherapy

Therapeutic horseback riding (THR) and Hippotherapy are horseback riding interventions that could help improve your child’s movement and posture. During THR, a trained riding instructor will teach your child to ride a horse using basic riding skills. In Hippotherapy, a physiotherapist or occupational therapist uses horse movements to improve your child’s motor skills, posture, and balance.

Hippotherapy and THR services can be found at:

You can find more information on therapy from these voluntary welfare organisations:

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Nutrition

Children with CP are at risk of poor nutritional status, especially if children have difficulties swallowing food. It is important for your child to have adequate nutrition for growth and development. It is also equally important that your child does not gain excessive weight that can cause additional problems with movement. A nutritionist, and a speech language pathologist (SLP) may help your child with nutrition and feeding.

As your child grows, his/her nutritional requirements will change. This depends on your child’s physical activity levels. A nutritionist will help determine your child’s nutritional requirements and suggest ways to help your child achieve those requirements.

Your child may find difficulties with chewing and swallowing food. A SLP would conduct assessments to identify if your child requires modifications to his/her meals. The SLP may recommend that your child eat certain textures of food and different thickness of liquids in order to prevent accidental inhalation of food into his/her airway. If your child has severe swallowing difficulties that pose a risk to him/her inhaling her food, a feeding tube may be appropriate. You may discuss this option with your child’s doctors.

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Assistive Technology Devices

Assistive technology devices are equipment that may help your child become more independent in his/her daily life. Your child’s therapists and other health professionals will assess and recommend devices that cater to your child’s needs. These devices may help improve your child’s posture, mobility, and communication. Among some of the devices that may enable your child:

  1. For posture and movement
  • Orthoses (Braces and splints)

Orthoses may be used to improve your child’s posture, and position your child’s limbs in order to facilitate better movement and function. They are usually custom made to fit your child.

  • Customised seating

Your child may require special seats that support his/her head and body to keep him/her stable and comfortable.

  • Walking aids (Crutches, walking frames)

Your therapist may prescribe walking aids to improve your child’s independence in mobility.

  • Wheelchairs

Your therapist may prescribe special wheelchairs to better support your child and allow him/her to be seated in a position that prevents awkward postures.

  1. For vision & hearing problems
  • Eyeglasses

If your child has visual problems, an ophthalmologist or an optometrist may prescribe custom eye glasses to improve your child’s visions.

  • Hearing aids or implants

If your child has auditory difficulties, a doctor may refer him/her to an audiologist to assess and prescribe suitable hearing aids. If your child is found to have severe hearing loss, your doctor may suggest ear implants.

  1. For communication: Augmentative and Alternative Communication devices

These devices can provide an alternative means of communicating if your child has difficulties producing speech. Your child will be able to tap on pictures on the device that produce a voice to indicate what your child is trying to communicate.

If you require financial help for obtaining assistive devices for your child, you may apply for the Assistive Technology Fund (ATF). The fund provides subsidies to help with the cost of assistive technology devices. To apply for the fund, an Application Admin (like a social worker) from Touchpoints (a hospital or voluntary welfare organisation) will have to submit your application to SG Enable once your child has been assessed by an Assessor (like a therapist). Once your application is processed, you will be granted a subsidy based on means testing. You will have to bear the remaining cost of the assistive device on your own. Should you require further assistance with the remaining cost, you may apply for the Special Assistance Fund (SAF). The SAF application is assessed along with your ATF application. You may apply for the ATF multiple times throughout your child’s lifetime, with a cap of $40,000.

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Medical Management

Some symptoms of cerebral palsy may require treatment using medicine and surgery. Most medical and surgical treatment work hand in hand with therapy to better enable your child. You should always discuss your child’s treatment options with your doctor to select the best course of action for your child.

Medical and surgical treatment:

  1. For seizures/epilepsy

If your child has been diagnosed with epilepsy, your doctor will often prescribe medication. The doctor will identify the type of seizure your child has and prescribe an anticonvulsant that has the least side effects. Your doctor should inform you if there are any side effects that may affect your child. For more information on epilepsy and its treatment, visit the National Neuroscience Institute website.

  1. For muscle stiffness
  • Muscle relaxants

Your doctor may sometimes prescribe oral medications to reduce muscle tightness. The common medication used are Diazepam, Dantrolene and Baclofen but they may cause side effects. For more information on muscle relaxants, you should speak to your child’s doctors.

  • Botox injections

If your child has extremely tight muscles that cannot be treated using therapy, your doctor may suggest Botulinum toxin A (Botox) injections. Botox is injected to relax specific muscles. The effects are only temporary, hence it would be best for your child to resume therapy after the treatment.

  • Selective dorsal rhizotomy

A major operation on the spine that is occasionally used to reduce spasticity in the lower limbs. The procedure is usually followed by extensive rehabilitation to enable your child to walk. You may read about the procedure from the United Kingdom National Institute for Health and Care Excellence (NICE) website.

  1. To correct deformities

Some children require surgery to correct scoliosis, hip dislocations, and ankle deformities.

  1. For feeding problems

If your child has severe swallowing difficulties, your doctor may recommend the use of a feeding tube. There are several types of feeding tubes available. You should talk to your doctor to select one that is best for your child.

You may read more about feeding tubes on the CP Family Network.

  1. For constipation

Constipation is a common problem among children with CP. To overcome this problem, your child may benefit from increasing his/her intake of fluids and fibre. It may, however, be difficult to achieve if your child has issues with feeding. Your doctor may prescribe laxatives to help ease your child’s bowel movements.

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Social Support

The Initial Diagnosis

When you first find out that your child has CP, you may feel anxious and stressed. Your mind may be filled with never-ending questions and you may feel alone.

Take your time to ask as many questions as you need. You may speak to doctors, other professionals, and parents of children with CP to get answers. A list of resources for parents of children with CP can be found below.

Remember that you are not alone. Talking to friends and family about what you’re going through may be helpful. This will also help them understand the special needs of your child better. You may also participate in support groups to meet other parents who are in a similar situation.

Every child is unique. They have their own individual personality and potential to learn. All children require love, security, encouragement, and opportunities to learn and grow. Treat your child like any other child to provide opportunities for your child to reach his/her fullest potential. You may be concerned about your child’s future, but take things one step at a time. You will find professionals along the way who will provide advice in making decisions for your child.

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Caring for the Caregiver

Raising a child with special needs is no easy feat. Your child may need a lot of assistance with his/her daily activities like bathing, eating, and dressing. There is also a large number of hidden costs to bear, such as therapies and special equipment, when raising a child with severe CP. This may place a large amount of stress on you and your family. You have your own individuals needs, and sometimes you may need a break from caregiving to rest and spend time doing things you need to.

Here are some tips for caring for yourself:

  • Engaging your family members

Though you may be your child’s primary caregiver, getting your family involved in the care of your child will ensure that you have support in planning day-to-day activities and decision-making. It may be tiring to juggle all of your child’s needs by yourself. So discussing with your family to share responsibilities might help you feel less isolated and less worn out. Family counselling is available at various voluntary welfare organisations, if you and your family require guidance.

  • Plan a break

It is important that you occasionally take time off to do things that you want. You should not let caring for your child consume your life. You have a right to schedule a break from your responsibilities without having a sense of guilt. It may help to plan your time off and arrange for your child’s care beforehand. Some of the care options you may consider:

  • Ask a relative or friend if they can help look after your child for a few hours
  • Utilise respite care, which provides temporary relief for caregivers. They can be found at daycare centres. Caregiver Asia is a website that will allow you to look for freelance home care services.
  • Share your struggles

Sometimes it is difficult to talk to your relatives and friends about what you are going through. Know that you are not alone. You may choose to participate in a support group at your child’s EIPIC centre or online forums to discuss your experiences with other parents of special needs children.

  • Understand your own limitations

As your child’s caregiver, you may have to juggle various roles and it may not be easy to achieve a balance. You have to know your limits and stop before you burnout. Nobody is perfect and you have to realise that you will not always be perfect when caring for your child. Take time to plan and set realistic goals for each day. Ask for help from family or friends when you need it.

  • Take good care of your health

You must remember that you can only take good care of your child if you take good care of yourself first. Here are some tips to live a healthy lifestyle:

  • Ensure that you get sufficient rest and sleep. This is essential not only for your health but to remain energetic.
  • Eat regular and healthy meals
  • Make time for regular exercise. You may use this time for a break, or bring your child along.

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Resources for Parents of Children with Cerebral Palsy

Baby Bonus

The Baby Bonus Scheme helps to lighten the financial costs of raising children.

Ministry of Education

Financial Assistance for SPED School Students

Grow @ Beanstalk

A website by the Early Childhood and Development Agency (ECDA) that provides parental guidance.

 

Special Seeds

A website where parents can find support and resources to enable their children with special needs.

Cerebral Palsy Support Network Singapore

A Facebook page for parents to share and discuss ideas, resources, and experiences of raising children with cerebral palsy.

Singapore Special Needs and Parents (SSNAP)

A support group to provide resources and a network for parents of children with special needs. You may also request to join their private Facebook group.

AWWA Family Service Centre
The Family Service Centre runs programmes for families, children, and youth to grow and overcome future challenges.

List of Inclusive Playgrounds

Inclusive Playgrounds are playgrounds that allow children with special needs to play alongside their siblings and other children. The playgrounds are equipped with accessible installations.

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Education

 

Early Years (Ages 0 to 6)

While CP cannot be cured, early treatment will often improve a child’s ability to participate in daily activities. The earlier your child begins treatment, the better chance your child has in improving muscle control or learning new ways to carry out tasks inhibited by his/her disability. In general, early intervention encompasses therapy, assistive devices, medication, nutrition, and educating parents on how to care for and your child with special needs.

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Early Intervention Programme for Infants & Children (EIPIC) Services

In Singapore, the Early Intervention Programme for Infants & Children (EIPIC) is available in various government-funded and private centres. EIPIC provides therapy and support services for children with special needs aged from a few months to 6 years. 

We have consolidated a list of the available EIPIC Centres and Private Intervention Centres (PIC) in the tables below.

For more details on this, you may want to read our helpful article on EIPIC Services for Children with Physical Disability.

Government-funded EIPIC Centres

Applications for admission to government-funded EIPIC centres may be done through SG Enable by referral from your child’s doctor.

These are the government-funded EIP centres that provide services for children with physical disabilities:

CentresLocationsContact
AWWA

Sessions and Duration:
2/3/5 days x 2.5 hours
About the programme
EIC@Fernvale
47 Fernvale Link Singapore 797537
6511 5621
EIC@Hougang
660 Hougang Ave 8 Singapore 530660
661 Hougang Ave 4 Singapore 530661
6511 7020
EIC@Kim Keat
195 Kim Keat Ave Singapore 310195
6511 5650
EIC@Napiri
11 Lorong Napiri Singapore 547532
6511 5300
Cerebral Palsy Alliance Singapore (CPAS)

Sessions and Duration:
4 days x 2 hours
About the programme6585 5647
hqadmin@cpas.org.sg
CPAS EIPIC
65 Pasir Ris Drive 1
Singapore 519529
EIPIC
Blk 630 Pasir Ris Drive 3 #01-364 Singapore 510630
Fei Yue Community Services

Sessions and Duration
First Steps Class: 2 days x 2 hours
Regular classes: 4 days x 2 hourss
About the programmekatherinekwan@fycs.org
Fei Yue Early Intervention Centre For Children (JE)
Blk 101 Jurong East St 13 #01-188
Singapore 600101
6565 6260
Fei Yue Early Intervention Centre For Children (WLC)
Blk 508 Wellington Circle #01-01
Singapore 750508
6431 0400
Fei Yue EIPIC Centre (Upper Thomson)
600 Upper Thomson Blk D #01-31
Singapore 574421
6565 6260
Rainbow Centre

Sessions and Duration
Infant: 1 day x 2 hours
Toddler: 3 days x 2 hours
Pre-schooler: 4 days x 2 hours
About the programme
Rainbow Centre Early Intervention Programme Margaret Drive (RC EIPMD)
501 Margaret Drive
Singapore 149306
64727077
nolita@rainbowcentre.org.sg
Rainbow Centre Early Intervention Programme Yishun Park (RC EIPYP)
15 Yishun St 61
Singapore 768548
64822592
jessiesarah@rainbowcentre.org.sg
SPD

Sessions and Duration:
Infants: 3 days x 1 hour
Children: 2 days x 3 hours or 3 days x 2 hours
About the programme
SPD Ability Centre
2 Peng Nguan Street
Singapore 268955
Ms Amily Goh
6579 0784
SPD @ Bedok
Blk 522 Bedok North Ave 1
Singapore 460522
Ms Junaidah Baharawi
6435 0255
SPD @ Jurong
Blk 337 Jurong East Ave 1 #01-1562
Singapore 600337
Ms Siti Hajar
6665 1844
SPD @ Tampines
866 Tampines Street 83 #01-237
Singapore 520866
Ms Kazel Yong
6587 7610
Thye Hua Kwan Moral Charities

Sessions and Duration:
3 days x 2 hours
About the programmeeipic@thkmc.org.sg
THK EIPIC Centre @ Ang Mo Kio
Blk 313 Ang Mo Kio Avenue 3 #01-2322
Singapore 560313
64999379
THK EIPIC Centre @ CCK
Blk 606 Choa Chu Kang Street 62 #01-139
Singapore 680606
67629125 / 64652167
THK EIPIC Centre @ Tampines
Blk 424 Tampines St 41 #01-188
Singapore 520424
67835338
THK EIPIC Centre @ Woodlands
Blk 716 Woodlands Drive 70 #01-124
Singapore 730716

There are also extended classrooms at:
Blk 646 Woodlands Ring Road #01-98
Singapore 730646
6362 5371 / 6362 6215 / 6362 2483
Extended Classrooms: 6367 8209

 

Enhanced Pilot for Private Intervention Providers (Enhanced PPIP)

If your child has been referred for EIPIC, you may choose to enrol your child in a Private Intervention Centre (PIC) instead of a government-funded centre. The Enhanced PPIP is a subsidy scheme that helps with the cost of enrolling your child in a PIC. 

Here is a list of PICs with approved programmes that cater to children with physical disabilities:

Private Intervention CentresAge rangeApproved ProgrammeServices IncludedServices at Additional CostDuration per week
Bright Path
55 Fairways Drive S(286846)
Tel: 6937 1374 / 6937 1245
Email: enquiries@brightpath.com.sg
3 to 6 yearsInclusive Early Intervention3 days x 3 hours
Genesis School
9 West Coast Road S(127296)
Tel: 6733 1172
Email: angie@genesisschool.com.sg
2.5 to 6 yearsPilot for Private Intervention Providers (PPIP)Caregiver trainingAll individual therapy services5 days x 3 hours
Ichiban Nurtureland Pte Ltd
31 Hong San Walk S(689022)
Tel: 67658426
Email: inpl_2003@yahoo.com.sg
3 to 6 yearsSUNCaregiver workshops & trainingAll individual therapy servicesSUN: 2 days x 2.5 hours
MOONMOON: 2 days x 3.5 hours
STARSTAR: 5 days x 2 hours 20 minutes
Mindchamps Allied Care @ Serangoon Gardens
7 Lichfield Road Serangoon Garden Estate S(556827)
Tel: 88269478 / 88269408
Email: sg.acserangoongardens@mindchamps.org
1.5 to 6 yearsMindChamps Allied Care Early Intervention ProgrammeCaregiver workshops & trainingAll individual therapy servicesWeekdays: 2 days x 3 hours
Weekends: 1 day x 6 hours
Thomson Paediatric Centre - The Child Development Centre
10 Sinaran Drive Novena Medical Centre #10-06/07 S(307506)
Tel: 63977073 / 63976627
Email: info@thomsonpaeds.com
2 to 6 yearsEarly Intervention Programme 2All individual therapy servicesEIP 2: 2 days x 3 hours
Early Intervention Programme 3EIP 3: 3 days x 3 hours

 

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Formal Education (Age 7 to 17)

Choosing the Right School

As your child approaches schooling age, you may begin to wonder if your child should attend a mainstream school or a Special Education (SPED) school. Every child is different and they progress at different paces. You may have noticed some difficulties in your child’s development and learning. If you have concerns regarding this, you may discuss with your child’s doctors, therapists and EIPIC teachers. They will be able to provide recommendations and identify if your child has any special education needs.

 

If your child has mild special education needs (SEN), they may perform well in a mainstream school. Your child is considered to have mild SEN if:

  • He/She has the mental ability to access the mainstream curriculum
  • His/Her needs can be met with minimal adaptation (like being able to access the curriculum with the use of assistive devices)
  • He/She has adaptive skills to cope with the mainstream learning environment (like having independent living skills)

 

If your child has moderate to severe SEN, they may perform better in a Special Education (SPED) School. Your child is considered to have moderate to severe SEN if he/she requires any of the following:

  • A specialised curriculum (e.g. life skills, adaptive skills, pre-vocational skills)
  • Specially-designed instructions
  • Specific expertise and provisions to support your child’s functioning level (e.g.intensive therapy services, low student-teacher ratio)

The Ministry of Education outlines how to select the right school for your child here.

 

Compulsory Education (National Primary School)

As of 2019, a child with/without special education needs is required to attend a national primary school. A national primary school may be a mainstream government/government-aided school or a government-funded SPED school.

You may apply for an exemption from the Ministry of Education (MOE) if your child:

  • is homeschooled according to the MOE’s criteria
  • upon professional assessment, your child’s learning needs are unable to be met in a national primary school, or your child is not able to attend any national primary school due to severe or complex conditions (including medical conditions)

For more information on Compulsory Education, visit the MOE website.

 

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Differences Between Special Education and Mainstream Schools

Ultimately, your choice of school for your child depends on his/her special education needs (SEN). If your child has more severe needs, a SPED school may be his/her best option to enable him/her to be more independent by learning daily living and vocational skills. If your child has cognitive skills that allow him/her to grasp the mainstream syllabus, then he/she might be more suited for mainstream education. For more information on support services available in mainstream schools, visit the MOE website.

This is a summary of differences between SPED and mainstream schools:

 

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Young Adults (Age 18 onwards)

 

Special Education Pathway

Once your child has completed his/her secondary education, you may be concerned about what’s next for your child. There is a wide range of options available based on your child’s abilities and interests. Transition Planning is a process that begins when your child is 13 years old up until he/she graduates from a SPED school. It will help you and your family identify your child’s abilities and interest to pursue post-school outcomes. The school will identify if your child is suited for employment, sheltered workshops, or day activity centers.

 

SPED schools provide a School-to-Work (S2W) Transition Programme as your child approaches the school leaving age. The programme is customised to match your child’s interests, preferences and strengths. It will help identify your child’s suitability for employment and liaise with SG Enable to match your child to a suitable employer.

 

The Cerebral Palsy Alliance Singapore (CPAS) provides vocational training at their Goodwill, Rehabilitation and Occupational Workshop (GROW). The programme includes social skill development, pre-vocational training, recreational activities, therapy, and counselling services for both you and your child.

 

For more information on the SPED education pathway, visit the MOE website.

 

Mainstream Pathway

Upon completion of secondary school, your child may choose to further his/her education. If your child chooses the academic pathway, he/she may decide to enrol in one of the following tertiary institutions:

For more information on courses available and admission criteria, contact the respective institutions.

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List of Special Education Schools

 

There are three Special Education (SPED) Schools in Singapore that cater to children with physical disabilities like CP.

 

AWWA School

Location and Contact Details

No. 11 Lorong Napiri, Singapore 547532

Tel: 6511 5280 | Fax: 6511 5281 | Email: school@awwa.org.sg

Curriculum

The students are grouped according to their abilities, needs and age. Each student has an Individualised Education Plan (IEP) (ages 7-12 yrs) or Individualised Transition Plan (ITP) (ages 13-18 yrs) to cater to their individual needs.

The IEP/ITP covers the following subjects: Language, Numeracy, Life Skill, Physical Education (PE), Art, Information & Communication Technology (ICT)

The ITP aims to prepare the students for transition after they leave the school.

Co-curricular Activities: Performing Arts, Clubs, Uniform Groups, Sports

Other Services

Services: Psychology, Nursing Department, Social Work

Therapy: Physiotherapy, Speech Therapy, Music Therapy, Occupational Therapy

School Hours

Morning Session: Monday and Tuesday 8:00 am – 12:00 noon, Wednesday to Friday 8:00 am – 1:00 pm

Afternoon Session: Monday and Tuesday 2:00 pm – 6:00 pm, Wednesday to Friday 1:00 pm – 6:00 pm

Fees

$86.00 per month

 

Rainbow Centre

Locations and Contact Details

Rainbow Centre – Margaret Drive School

501 Margaret Drive, Singapore 149306

Tel: 6472 7077 | Email: rcmds@rainbowcentre.org.sg

Rainbow Centre – Yishun Park School

15 Yishun Street 61, Singapore 768548

Tel: 6482 2592 | Email: rcyps@rainbowcentre.org.sg

Curriculum

Each student gets an Individualised Education Plan (IEP) to provide a well-rounded education according to their specific needs.

The curriculum is designed to meet the students’ changing learning needs at different life stages:

Junior Programme (7-10 years old), Middle Programme (11-14 years old), Senior Programme (15-18 years old)

Focus: Daily Living, Social Emotional Learning, Language and Communication, Numeracy, Physical Development, Vocational Development

Co-curricular Activities: Leadership, Sports, Arts, Digital

Other Services

Therapy: Physiotherapy, Occupational Therapy, Speech Therapy

The Family Life Services (FLS) unit:

  • Social workers address specific challenges that families may face when caregiving for and parenting their child with disability
  • Family support groups
  • Facilitate transition planning for students preparing for life after school

School Hours

Contact the centre for more details.

Fees

Basic fee $60.00 per month

 

Cerebral Palsy Alliance Singapore School (CPASS)

Location and Contact Details

65 Pasir Ris Drive 1, Singapore 519529

Tel: 6585 5640 | Fax: 6585 5635 | Email: cpasschool@cpas.org.sg

Curriculum

Learning domains:

  • Social-Emotional
  • Academic (Literacy, Numeracy and Science)
  • Daily Living
  • Vocational
  • Physical Education and Sports
  • The Arts

Programmes offered:

1. The High Support Programme caters to students with moderate to high support needs in all areas of their daily living and learning. These students require more assistance in mobility, fine motor skills, self-help, and learning, and will pursue lessons that will promote their well-being. Upon graduation at the age of 18 years, possible post-school outcomes are the Day Activity Centre or Home Management Programme.

2. The Functional Programme caters to students with mild to moderate support needs in most areas of their daily living and learning. In the senior level, students will learn pre-vocational skills that will support their learning in the vocational domain. Students who demonstrate potential for open employment or sheltered employment, will be trained in the school’s social enterprise. Upon graduation at the age of 18 years, students may transition to a Day Activity Centre or Sheltered Workshop.

3. The Academic Programme caters to students with mild support needs in most areas of their daily living and learning. Students in this programme follow the mainstream MOE curriculum for English, Mathematics and Science only, in addition to the Curriculum Framework for SPED Schools. At the age of 9 years, students in this programme are assessed for suitability for education in mainstream primary schools before they transit there. If that is not possible, they can continue to pursue their education following the mainstream curriculum at CPASS and prepare for their Primary School Leaving Examination (PSLE) at the age of 12 to 15 years old. Upon attaining their PSLE, students will transit to mainstream secondary schools or specialised schools. If they do not pursue secondary education, these students will continue their education at CPASS and prepare for employment in the open market or sheltered employment when they graduate at the age of 18 years.

Other Services

Rehabilitation Services: Physiotherapy, Occupational Therapy, Speech and Language Pathology, Psychology Services, Social Work Services, Medical and Dental Services

School Hours

Morning Session: Monday to Thursday 8:00 am – 12:30 pm, Friday 8:00 am – 1:30 am

Afternoon Session: Monday to Thursday 12:30 pm – 5:00 pm, Friday 1:30 pm – 5:00 pm

Fees

Contact the centre for more details.

 

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List of Mainstream Schools with Barrier-Free Accessibility

If your child has mild special education needs, there are mainstream schools in Singapore that may provide services to support your child. There are 57 primary schools and 35 secondary schools/Junior Colleges/ Centralised Institutes that have barrier free accessibility for children with physical disabilities. This means that the schools have better facilities like disabled toilets, ramps and lifts for those with limited mobility.

School Zones Primary Schools Secondary schools & Junior Colleges
Ang Mo Kio CHIJ St Nicholas Girls’ School (Primary) CHIJ St Nicholas Girls’ School (Secondary)
Teck Ghee Primary School Yio Chu Kang Secondary School
Bedok Fengshan Primary School Bedok South Secondary School
St. Anthony’s Canossian Primary School St. Anthony’s Canossian Secondary School
Temasek Primary School
Yu Neng Primary School
Bishan Guangyang Primary School Peirce Secondary School
Raffles Institution
Bukit Batok Dazhong Primary School Hillgrove Secondary School
Millennia Institute
Bukit Merah Alexandra Primary School CHIJ St Theresa’s Convent
Cantonment Primary School
Bukit Panjang West Spring Primary School Assumption English School
Fajar Secondary School
Zhenghua Secondary School
Bukit Timah Methodist Girls’ School (Primary) Methodist Girls’ School (Secondary)
Bukit Timah Primary School
Central River Valley Primary School Outram Secondary School
Stamford Primary School Raffles Girls’ School (Secondary)
Chua Chu Kang Chua Chu Kang Primary School Kranji Secondary School
De La Salle School
Clementi Kent Ridge Secondary School
Geylang Kong Hwa School
Maha Bodhi School
Hougang Punggol Primary School Montfort Secondary School
Xinghua Primary School
Jurong East Jurongville Secondary School
Jurong West Frontier Primary School Westwood Secondary School
Pioneer Primary School Yuhua Secondary School
Shuqun Primary School
Westwood Primary School
Kallang Bendemeer Primary School Bendemeer Secondary School
Marine Parade Tanjong Katong Primary School Tanjong Katong Secondary School
CHIJ Katong Convent
Pasir Ris Elias Park Primary School
Punggol Oasis Primary School Edgefield Secondary School
Punggol Cove Primary School Punggol Secondary School
Punggol Green Primary School
Punggol View Primary School
Waterway Primary School
Edgefield Primary School
Horizon Primary School
Queenstown Queenstown Primary School Anglo-Chinese School (Independent)
Queenstown Secondary School
Queensway Secondary School
Sembawang Canberra Primary School Sembawang Secondary School
Northoaks Primary School
Sembawang Primary School
Sengkang

 

Sengkang Green Primary School Seng Kang Secondary School
Springdale Primary School
Compassvale Primary School
Nan Chiau Primary School
Palm View Primary School
Seng Kang Primary School
Serangoon Zhonghua Primary School
Tampines Tampines North Primary School Changkat Changi Secondary School
Tampines Primary School St. Hilda’s Secondary School
Toa Payoh First Toa Payoh Primary School
Marymount Convent School
Woodlands Evergreen Primary School Admiralty Secondary School
Marsiling Primary School Woodgrove Secondary School
Riverside Primary School
Yishun Ahmad Ibrahim Primary School
Naval Base Primary School
North View Primary School
Xishan Primary School

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School Application Procedures

If you have decided that a mainstream education would be the best for your child, you may enrol your child by participating in the Primary One Registration Exercise.

If you have decided that your child would perform better in a SPED school, the application process is slightly different. Different schools have different points of admission each year. You would have to contact your preferred school(s) for more information.

You may apply for your child to enrol in a SPED school using the MOE’s standardised application form. The form consists of four sections which need to be completed by you, and your child’s teachers and health professionals. You may find the application form and the user guide to complete the form can be on the MOE website.

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FAQ

Myths and Facts

There are still many misconceptions about cerebral palsy due to a lack of education on the topic or misinformation in society. Our hope is that these facts would become common knowledge as our society grows to be a more inclusive one.

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Common Questions

Will my child get better?

Cerebral palsy is a permanent condition with no cure. Hence, the problems that your child has associated with CP (like muscle weakness or stiffness) will remain throughout his/her lifetime. However, your child can learn to cope with the condition through therapy as they grow.

Will my child’s condition deteriorate?

No, CP is a non-progressive condition. This means that the damage done to your child’s brain will not worsen over time. As your child grows, however, the features of the condition may change. Sometimes it may seem that your child’s muscles are tighter. This may be due to his bones growing faster than his muscles causing the muscles to be stretched and tightened. The tightness may be managed through therapy and medication as the muscles take time to grow.

Does having Cerebral Palsy mean that my child has an Intellectual Disability?

Not all children with CP have an Intellectual Disability. CP may affect many areas of your child’s development, including his/her mental functions. Your child may have mild to severe Intellectual Disability, or none at all. Many children with CP suffer from physical disabilities but are still able to attend mainstream schools. If your child has an Intellectual Disability, you may discuss your concerns with your child’s teacher and health professionals. They may offer advice on what form of education is suited for your child.

Will my child be able to walk?

It is not possible to determine your child’s progress shortly after he/she is diagnosed with CP. Your child’s growth and development will continually be observed by doctors and therapists. This will be helpful in determining if your child is likely to learn to walk.

Will my child learn to talk?

Some children with CP have difficulties with communication, while others are able to talk. If your child has problems with speech, a Speech language pathologist may help in finding alternative methods of communication for your child.

Can my child die from cerebral palsy?

CP is not a fatal condition, so your child cannot die from CP. However it is a condition with many accompanying issues. Some of these issues may lead to medical complications such as lung infections that may deteriorate your child’s health. Therefore, it is important that you seek early treatment for your child to prevent the development of complications.

Will my next child have cerebral palsy?

CP is not a hereditary condition, so the chances of your next child having CP is unlikely. You should, however, discuss your plans of future pregnancies with your doctor.

What is the life expectancy of a child with cerebral palsy?

The survival of a child with CP depends on the severity of their disability. Many of those with mild symptoms may have a regular lifespan. In some instances, children with very severe symptoms and medical complications (like lung infections or severe seizures) may have reduced life expectancy.

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Cerebral Palsy Stories in Singapore

Gemma Rose Foo

Para-Equestrian Gemma Rose Foo kept on going despite all obstacles

Wesley Wee

Finding happiness against the odds

Wesley’s blog

Wesley’s book

 

Hitesh Ramchandani

This S’porean Didn’t Allow Cerebral Palsy To Stop Him From Becoming An Athlete, International Speaker And His Own Boss

Laurentia Tan

How Laurentia Learned to Fly (An interview with the Federation Equestre Internationale)

Ng Xiu Zhen

Singapore Sailor with Cerebral Palsy Finds Her Safe Place at Sea

Noraini Adnan

DISABILITY ADVOCATE WITH CEREBRAL PALSY: “I NEVER GAVE UP HOPE”

Oh Siew May

Article: ‘I have never treated myself as disabled’

Video: Beyond Cerebral Palsy: The life of Oh Siew May (2014)

Muhammed Sayfullah

Article: Setting my son, the trapped chatterbox, free
Video: Finding Sayfullah’s Voice

Seng Boon Hock

Article: Extraordinary People: In a life of limitations, frustration slowly turns into determination

Video: Extraordinary People: The Seng Family

 

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References

Birth Injury Guide

https://www.birthinjuryguide.org/cerebral-palsy/

Cerebral Palsy: An information guide for parents (Fifth edition 2008). The Royal Children’s Hospital, Melbourne.

Cerebral Palsy: An information guide for parents and families (Fourth edition 2016). The Royal Children’s Hospital, Melbourne.

Causes and risk factors of cerebral palsy. Centers for Disease Control and Prevention United States Department of Health and Human Services.

https://www.cdc.gov/ncbddd/cp/causes.html

Cerebral Palsy Guidance

https://www.cerebralpalsyguidance.com/

Cerebral palsy in under 25s: assessment and management. NICE guideline.

https://www.nice.org.uk/guidance/ng62/chapter/Recommendations

Cerebral palsy information, advice and support for parents during the early years. Scope.

https://cpaustralia.com.au/media/22643/Scope_Parents_CP_guide.pdf

Cerebral Palsy. National Health Service United Kingdom.

https://www.nhs.uk/conditions/cerebral-palsy/

K.L. Bell, L. Samson-Fang. Nutritional management of children with cerebral palsy. European Journal of Clinical Nutrition (2013) 67, S13–S16

2007. Snider, N. Korner-Bitensky, C. Kammann, M. Saleh. Horseback Riding as Therapy for Children with Cerebral Palsy: Is There Evidence of Its Effectiveness?. Physical & Occupational Therapy in Pediatrics, Vol. 27(2) 2007. doi:10.1300/J006v27n02_02

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