#21
HOT TIPS
A Tip Sheet For Physical Educators
Feature Activity
EVOLUTION
This game is based on “Rock, Paper, Scissors (RPS),” and begins with the entire
group scattered over the playing area. The following are the levels of “species” and
the corresponding actions:
1. Frog - must hop around on all fours and say “Ribbit.”
2. Chicken - must walk with
bent knees and with
hands tucked in
armpits and say
“Bawk, Bawk” or
“Cluck, Cluck.”
3. Monster - must walk upright with arms
outstretched over-head and say “Gr-r-r-r.”
4. Supreme Being - must stand around
playing area and observe remaining
players with a bemused disregard.
Rules:
1. Everyone starts out as a frog.
2. You may only play RPS with someone of
the same species.
3. The winner of RPS evolves to the next
species.
4. No one loses, but some players do get
stalled on their way up the evolutionary
ladder.
5. Play ends when there is only one frog,
chicken, and monster remaining.
Variation:
The loser of RPS “devolves” back to the next lowest level.
GRANT WOOD
AREA EDUCATION AGENCY
4401 Sixth Street SW
Cedar Rapids, IA 52404-4499
Hot Tips #21
Fall1996
Published by the Adapted Physical Education Department, Grant Wood Area Education
Agency, 4401 Sixth Street SW, Cedar Rapids, Iowa 52404. Additional copies are available
upon request. Editors: Ann Griffin and Janice Sewell, 319-399-6871, 1-800-798-9771, ext.
6871; TDD 319•399-6766. Production by Grant Wood AEA Graphics & Printing Staff.
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
1
Cerebral Palsy (CP)
Cerebral palsy (CP) is the orthopedic impairment most often found in the public
schools. “Cerebral” refers to the brain. “Palsy” describes the lack of muscle control that
is often a symptom. Cerebral palsy is a chronic neurologic disorder of movement and
posture caused by a defect or lesion of the immature brain and accompanied by associated dysfunctions. It is permanent and non-progressive. It is not a disease, hereditary,
contagious, progressive, or life-threatening. The condition is more common among the
white race than the black race; males than females; the firstborn. The disorder varies
from mild (generalized clumsiness or a slight limp) to severe (dominated by reflexes,
unable to ambulate except in motorized chair, inability to speak, and almost no control of
motor function).
FACTS ABOUT CEREBRAL PALSY
CAUSES OF CP
In about 90% of individuals with CP, damage to the brain occurs before or during birth due to:
• maternal infections or health problems (AIDS, rubella, herpes, German measles, diabetes, high blood
pressure)
• chemical toxins (alcohol, tobacco, prescribed and nonprescribed drugs)
• injuries to the mother that affect fetal development
• RH incompatibility
• lack of oxygen
• prematurity and low birth weight
About 10% of cerebral palsy occurs early in life due to:
• brain infections (encephalitis, meningitis)
• cranial traumas (accidents, child abuse, chemical toxins)
• oxygen deprivation
EXTENT OF INVOLVEMENT
• Paraplegia - involvement of the lower extremities only
• Hemiplegia - involvement of the entire right side or left side
• Triplegia - involvement of three extremities, usually both legs and one arm
• Quadriplegia - involvement of all four extremities
• Diplegia - lower extremities much more involved than upper extremities
Cerebral Palsy ➤ cont. next page
2
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
Fall1996
Hot Tips #21
Cerebral Palsy cont.
DEGREE OF MUSCLE TONE
Individuals with CP will have abnormal muscle tone to varying degrees. The symptoms vary from severe to mild,
from person to person, and from time to time in the same person. Although most persons have mixed types, three
types of CP are recognized: spastic, athetoid, and ataxic.
• Spastic - Muscle tone is hypertonic (tense, contracted) which restricts movement. The individual has difficulty relaxing muscles when attempting purposeful movement. This is the most common type of CP.
• Athetoid - Muscle tone is low or it fluctuates (muscles are limp). There is a constant, slow, uncontrolled and
purposeless motion of the limbs, head and eyes.
• Ataxic - The muscle tone fluctuates. The individual shows a lack of coordination, poor balance, an unsteady
gait, and lack of understanding of position in space.
ASSOCIATED IMPAIRMENTS
Depending on the location and extent of the damage to the brain, an individual with CP may have any of the
following associated impairments:
▲ visual
▲ speech/language
▲ inappropriate
▲ auditory
▲ mental
▲ seizures
retardation
social behaviors
ABNORMAL REFLEX DEVELOPMENT
The motor development and movement of individuals with CP may be restricted as a result of the retention of
primitive reflexes.
• Asymmetrical
Tonic Neck
Reflex (ATNR)
- When the head is
turned to one side, the
arm on the side to which
the head is turned extends
and the other arm flexes.
Encourage the individual
to face forward during
physical activity to
minimize the affects of
this reflex.
• Symmetrical Tonic
Neck
Reflex
(STNR) When the
head is moved
toward the
chest, it causes
the arms to flex
and the legs to
extend. When the
head is raised, it
causes the arms to
extend and the legs
to flex. This reflex prevents some children with CP
from crawling.
Cerebral Palsy ➤ cont. next page
Hot Tips #21
Fall1996
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
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Cerebral Palsy cont.
ABNORMAL REFLEX DEVELOPMENT continued
• Tonic Labyrinthine Reflex (TLR) When lying on the
stomach, the legs and
arms flex. When
lying on the back, the
legs and arms extend.
This may result in
restricted movement.
• Moro Reflex (MR) and
Startle Reflex (SR) - These
reflexes occur when a loud
noise or sudden jar occurs.
MR limbs extend apart and
then come together. SR
reflexes are present in all
adults but are more
exaggerated in those with
CP.
• Positive Support Reaction (PSR) - Stimulus to
the individual’s feet results in the extension of
the hips, knees, and toes. This may result in an
awkward gait or in an inability to walk.
Illustrations modified from: (Canadian Cerebral Palsy Sports Assoc., 1994) and (Sherrill, 1993).
IMPLICATIONS FOR PHYSICAL EDUCATION
ACCOMODATIONS AND TEACHING STRATEGIES
RESPECT THE PERSON
• Always see and encourage the potential ability of the student.
• Discuss with the entire class the importance of acceptance of others with varying abilities,
the facts about CP, and the capabilities of the student in the class who has CP.
• Treat the student with CP the same as any other student.
• Ask the student with CP questions and encourage him/her to ask questions.
• Have the class determine ways to include the student with CP.
• Respect the dignity of the student with CP and, if necessary, arrange for private showering
and toileting
Activities: Recommended/Contraindicted ➤ next page
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Published by Grant Wood Area Education Agency, Cedar Rapids, IA
Fall1996
Hot Tips #21
CEREBRAL PALSY . . .
IMPLICATIONS FOR PHYSICAL EDUCATION . . . continued from page 4
ACTIVITIES: RECOMMENDED/CONTRAINDICATED
Spastic CP
• Avoid activities, such as walking on toes and toe pointing
• Recommended activities include walking up inclined surfaces; swimming in warm water; horseback riding;
dances emphasizing extension, good posture, and heels and flats
Athetoid CP
• Activities such as tricycling, bicycling (stationary/moving) and horseback riding are good and reinforce
midline control.
• Bridging in supine (pushing down with feet and lifting pelvis from mat) should be discouraged.
• The best performance is achieved if rest and relaxation occur between movements.
Ataxic CP
• People with ataxia do not perform well in skills requiring balance and kinesthesis.
• Use wrist weights between 1/4 and 1 pound to decelerate unwanted movement and facilitate performance.
ADAPTATIONS FOR MANIPULATIVE SKILLS
Throwing
• Use a chute/ramp to ensure success in games
such as bowling, boccia, and shuffleboard
• Use a bucket
of balls for
easy access
• Have the student work on
dropping objects if he/she
is unable to throw
• Tie a ball or
frisbee to the
arm of a
wheelchair for
independent
retrieval
• Use beanbags,
tied scarves, yarn
balls, sponge balls, Nerf
balls or slo-mo balls which are easily grasped
• Use velcro pads for targets (place on floor, wall,
table, etc.)
• Use objects of varying
weights (e.g., a small
heavy ball such as a
handball assists in the
“release”)
• Move the
student’s arm
through the
throwing action
so he/she understands the movement
Adaptations for Manipulative Skills ➤ cont. next page
Hot Tips #21
Fall1996
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
5
CEREBRAL PALSY . . .
IMPLICATIONS FOR PHYSICAL EDUCATION . . . continued from page 5
ADAPTATIONS FOR MANIPULATIVE SKILLS—cont.
Throwing cont.
forward a few steps, running or sitting is the preferred
position from which to throw
• Adjust the student’s wheelchair to different
positions, i.e., facing the direction of the throw,
sideways or backwards to the direction of the
throw. Find the position that works best for the
student.
• Substitute kicking events for throwing events for
those who have difficulty with grasp/release
• Lower the back of the wheelchair to increase the
student’s ability to rotate in the chair
• Utilize a catapult (Hot Tips #18) to “put objects into
play” if throwing is ineffective
• Use the student’s ability to balance to determine
if standing stationary, standing and stepping
• Attach a ball to a fishing reel for easy retrieval
Catching
• Use beanbags, scarves, rolled up socks or balls
made of sponge, cloth, rubber
• Reduce the fear of catching by using a balloon,
beachball, or slo-mo ball
• Position the student with his/her back to the wall
to minimize retrieval time
• Suspend balls for individual or partner practice
time
• Use catching devices such as a velcro glove or
pad or a plastic scoop
• Attach a velcro pad to the student’s chest strap
for catching tennis balls
• Encourage students with limited balance to sit
while catching
• Attach a sheet with clothespins
to a volleyball net to make a
ball return
and
increase
the
number of
trials
• Use a
bounce
back net
with a beanbag attached to a chair
• Use a zoom or a
trac-ball if
throwing and
catching are
impossible.
Kicking
• Use large light balls (balloons, beachballs)
• Remove footplates on wheelchairs
• Tether a ball with elastic to the wheelchair
• Use crutch or wheelchair to “kick”
• Place beanbags on the student’s feet and ask him/
her to kick them off
• Suspend a weighted ball
Adaptations for Manipulative Skills ➤ cont. next page
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Published by Grant Wood Area Education Agency, Cedar Rapids, IA
Fall1996
Hot Tips #21
CEREBRAL PALSY . . .
IMPLICATIONS FOR PHYSICAL EDUCATION . . . continued from page 6
ADAPTATIONS FOR MANIPULATIVE SKILLS—cont.
Striking
• Use balls, balloons, birdies, tethered balls
• Strike with hands, wands, racquets, or other
implements
• Use implements with shortened handles
• Remove wheelchair arm rests to facilitate
body motion
• Determine the optimal wheelchair position for
striking
• Use velcro or ace bandages to secure hands to
implements
• Determine the optimal striking technique for
the student: overhand, underhand, sidearm,
backhand
• Place balls on a batting tee, suspend
them, or throw them slowly
• Lower the back of the wheelchair to increase
range of arm motion and trunk rotation
• Provide whatever balance support is needed
for ambulatory students (walker, chair, wall)
• Attach striking implement to wheelchair
• Use implements
that can be held
with two hands
(two-handled
paddle) in games
such as balloon
tetherball or
table tennis
• For further
adaptations, see
Hot Tips # 11,
13, 18
FACILITATING MOVEMENT
Provide movement experiences for younger non-ambulatory students who
can initiate very little movement on their own: swing in a blanket or
hammock; pull on a blanket; push in a cardboard box; ride in/on an
adapted tricycle, big wheel, wagon, walker, walker on wheels with seat,
utility cart, scooterboard; roll in a fiber barrel; swing on a rope.
Implications For Physical Education ➤ cont. next page
Hot Tips #21
Fall1996
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
7
CEREBRAL PALSY . . .
IMPLICATIONS FOR PHYSICAL EDUCATION . . . continued from page 7
FITNESS
• Students with CP expend more energy than their peers (need to run less distance for similar benefits).
• Periodic rest breaks may be needed to relax muscle groups.
• Students in wheelchairs need to develop muscle strength for transport skills (stretch biceps, strengthen
triceps).
• Daily warm-ups should include slow sustained stretching of wrists, biceps, heel cords, hamstrings, neck,
fingers, ankles and shoulders.
• Have the student perform stretches in various locations: in wheelchair, on a bench, on floor mat.
• Have classmates do stretching in the same position as the student with CP, i.e., from a sitting or lying position.
• Excessive repetitive movements may decrease range of motion and lower potential strength gains.
• Students with CP need to learn how to pace themselves in cardiovascular activities so that spasticity is not
increased and efficiency of movement decreased.
• Give physical assistance in performing stretches as needed.
HANDLING TECHNIQUES
Check with OT, PT or APE Consultant regarding techniques for reducing spasticity, transferring to and from
wheelchair, and correcting abnormal postural reactions.
MOBILITY
• Encourage individuals with CP to move as independently as possible using whatever mobility aide is available.
• Wheelchair users should work to improve ability to move the wheelchair in a variety of settings.
• Wheelchair users should experience other forms of movement such as crawling, creeping, rolling, bouncing, etc.
• Move in threes, with two outside peers performing the skill, e.g., gallop.
MOTOR PERFORMANCE
The motor performance of the individual with spastic CP deteriorates and spasticity increases with excessive
excitement, as the student attempts to move faster in an activity (e.g., scissoring of legs when running), and when
attempting an activity that is difficult.
• Give calm support and instill confidence rather than “psyching” up.
• Incorporate warm-up exercises into the student’s program. Stretching exercises done by the individual
without assistance (active) are more effective than passive exercises.
• Adapt the activity at a lower skill level to develop the basic motor patterns needed for the activity and
increase the difficulty as confidence and skill level increases.
• Individuals with spasticity should learn relaxation and stress control techniques.
• Movements that are continuously repeated are easier for those who have spasticity.
• Warm temperatures relax the stiff muscles of those individuals with spastic CP.
• Cool temperatures may improve the performance of individuals with athetoid CP.
Implications For Physical Education ➤ cont. next page
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Published by Grant Wood Area Education Agency, Cedar Rapids, IA
Fall1996
Hot Tips #21
CEREBRAL PALSY . . .
IMPLICATIONS FOR PHYSICAL EDUCATION . . . continued from page 8
POSITIONING
• Discourage “W” sitting and encourage other floor positions such as long-, tailor-, side-, or
ring-sitting; or sitting with support (back against the wall or heavy object).
• For better arm and trunk control, stabilize the body by holding the student’s hips.
• The student in a wheelchair should be positioned so the hip, knee and foot angles are at
90 degrees (unless instructed otherwise).
• Students with ataxic CP need to increase stability in the trunk and non-participating limbs and to gain control
in the action limb.
• Perform the skill in a stationary position (kneeling; holding onto chair, walker or wall).
• Use 1/4 to 1/2 pound wrist or ankle weights.
RESPONSE/REACTION/PROCESSING DELAYS
• A longer period of time is required to respond to a request. Count to 7 before rephrasing a question or
physically assisting to allow the student the opportunity to independently complete the task.
• Those with spastic hemiplegic cerebral palsy require more time to plan a simple aiming movement.
• Allow more time to plan and execute actions that require accurate limb positioning or involve small targets.
• Utilize a gradual progression from larger body movements to those requiring more precise coordination of
limbs to offset processing difficulties.
• Provide larger endpoint targets in kicking and striking activities.
SEIZURES
Students who have seizures may be unable to continue with an activity and require a rest period. Know what to do
when a seizure occurs and report the incident to the classroom teacher and the parents.
SIGNALS
DO NOT use a whistle or starting gun because of the Moro or Startle Reflex which may be present.
TRANSFERS
Students with CP should get out of their wheelchairs as often as possible for warm-ups and other activities. While
some are able to transfer independently, others require assistance. The student who is being transferred should
participate in the transfer as much as possible and should be informed that the transfer is about to occur (adult gives
a consistent count of 1, 2, 3, lift). Transfer tips:
• Lock the wheelchair brakes.
• Inform the student that you are going to begin the transfer.
• Minimize the distance between the wheelchair and the new position.
• Lift with your legs and not your back.
• Perform two person transfers when the student’s body weight and size make one person transfers unsafe.
Transfers ➤ cont. next page
Hot Tips #21
Fall1996
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
9
CEREBRAL PALSY . . .
IMPLICATIONS FOR PHYSICAL EDUCATION . . . continued from page 9
TRANSFERS—cont.
Transfer from chair to floor
Transfer from floor to chair
Transfer from wheelchair to floor (2 person)
Transfer from floor to chair (2 person)
Illustrations modified from (Canadian Cerebral Palsy Sports Assoc., 1994)
REFERENCES
Canadian Cerebral Palsy Sports Association. (1994). Active living through physical education: maximizing opportunities for
students with cerebral palsy. Gloucester, ON: Canadian Cerebral Palsy Sports Assoc.
Sherrill, Claudine. (1993). Adapted physical activity, recreation and sport - crossdisciplinary and lifespan. (4th. ed.). Dubuque,
IA.: Brown & Benchmark Publishers.
Parks, S. I., Dunn, J. M. & Rose, D. (1989). A comparison of fractionated reaction time between cerebralpalsied and
non-handicapped youths. Adapted Physical Activity Quarterly, 6(4), 379-388.
United Cerebral Palsy Association, Inc. What everyone should know about cerebral palsy. New York, NY.
10
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
Fall1996
Hot Tips #21
Ideas and Resources
Juggling Thuds (balls):
Softshare Catalog ($3.00)
AAHPERD Publications
PO Box 385
Oxon Hill, MD 20750-0385
800-321-0789
Catalog of computer software programs
for physical education and related areas.
Softshare disks are available for $7.00
each. Several programs are
“shareware.”
Basketball Modification Kit
Materials needed:
dead tennis balls
small round balloons
scissors
1.
1. Poke a small hole in the
tennis ball with sharp
scissors or knife.
2. Squeeze the air out of the
ball.
2.
Available for check-out from GWAEA
Adapted PE Department
Basketball Resource Guide (modifications,
parallel activities, skill stations, lead-up
games, cooperative games, plan for inclusion, resources, references)
3. Submerge ball in water
and release to fill with
water.
3.
Basketballs (different sizes, textures)
Goals (portable system, floor goal)
Tabletop Basketball Games
4. Snip the neck off of
two balloons.
4.
5. Put the first balloon over the tennis ball covering the hole to seal
in the water.
5.
6. Place the second balloon over the open end of the first balloon.
6.
The water adds weight to the ball and decreases the bounce.
The balloon cover makes the ball easy to grip.
“Trick” balls can be made by unequally or partially filling the balls with water.
Hot Tips #21
Fall1996
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
11
What’s New
To check these materials out of the GWAEA Media & Technology
Center, call (319) 399-6745 or 1-800-332-8488, ext. 6745
Books
R796.07 STR
Assessing Sport Skills
R793.545 SIE
Children’s Traditional Games
R375.613 MEL Designing the Physical Education Curriculum. Third Edition
R796.332 SHU
Everyone’s a Coach: You Can Inspire Anyone To Be a Winner
R790.192 SIL
500 Five Minute Games
R796.019 KAS
Inclusive Games
R152.384 BEN
More Moving Experiences
R371.9 ACT
Moving to Inclusion. Active Living Through Physical Education (9 books):
Maximizing Opportunities for Students with:
Visual Impairments
Physically Awkward
Multiple Disabilities
Cerebral Palsy
Deaf or Hard of Hearing
Wheelchair
Intellectual Disabilities
Skiing
Amputation
R372.86 DEV
NASPE Pamphlets (3 titles): Developmentally Appropriate
Practice in Movement Programs for Young Children Ages 3-5
Physical Education Practices for Children
Practices for Middle School Physical Education
S 3G
Ready-To-Use P.E. Activities for Grades: K-2, 3-4, 5-6, 7-9
R796.019 SPO
Sport Education: Quality PE Through Positive Sport Experiences
Videos
20-309613 to 20-309638 Free to Fly 2 (physical education program for young children) (26 programs)
12
Published by Grant Wood Area Education Agency, Cedar Rapids, IA
Fall1996
Hot Tips #21