ADOLESCENTS WITH CEREBRAL PALSY:OVERCOMING CHALLENGES OF SELF-WORTH

written by Altavia L. Evans, Undergraduate Student, University of Florida,
and Christine Stopka, Professor, Health Education & Behavior, University of Florida

During late childhood and all through adolescence, self-concept becomes increasingly important. This is a time of rapid change, and differences between the genders become more apparent. Sometimes these changes have either a positive or negative effect on the way these youth perceive themselves. Their self-image, self-worth, and self-esteem all change based on how they see themselves. When disabilities enter into the equation, situations can become more complicated. Thus, the purpose of this article is to take a look at the effect and the importance, of self-concept (i.e., self-image, self-worth, and self-esteem) in individuals with disabilities; and more specifically, those with cerebral palsy.

Cerebral palsy (CP) is "a condition, sometimes thought of as a group of disorders that can involve brain and nervous system functions such as movement, learning, hearing, seeing, and thinking" (PubMed, 2009). It is often categorized as these types: spastic, dyskinetic, ataxic, hypotonic, or a mixture. Since motor functions are affected, it is important to find ways to adapt or overcome life's daily physical challenges (Bachrach, 2009).

As is pointed out in Maslow's Hierarchy of needs, it is human nature to feel safe, loved, establish a good self-esteem, and become self-actualized. Although difficult, this is still highly obtainable for adolescents with CP. In a study by Nora Shields and her colleagues (2007), children with CP (different children with various types of CP were tested) appeared to not have a lower sense of self-worth than their fellow peers without this disability. In fact, their view of themselves was very positive. The only negative finding with regards to self-concept, dealt with athletic competence. This suggests that they do recognize their physical difference and acknowledge that they can be held back.

Another thing that this study suggests are the false assumptions in regard to individuals with a disability (CP, in this instance); many people automatically assuming that disabled people have lower self-esteem due to their difference. However, since the results disproved this, it suggests others without disabilities only assume this myth due to their lack of education and negative stereotypes of which they may hear about children with CP children having a lower self-esteem.

As an educator, it is imperative to dispel these myths. It is especially important to teach parents, who may feel this way towards their own children. This type of stereotype may hinder their son/daughters' ability to progress in areas such as thinking and social interacting. They may feel like they have to live up to the stereotype that they are different, and it's okay that they are a little slower. However, children with CP are not necessarily slower. If anything, it may take them a little longer to respond or physically complete a task. But, they will accomplish the task, even efficiently (given the proper therapy and training).

Another study by Russo (2008) and his colleagues support the findings of the previous study. He and his teammates noted that "global self-worth revealed no significant differences, nor did physical appearance, social acceptance, or behavioral competence." This means that even at a young age, children with this condition are well established based on Maslow's hierarchy. They feel safe and accepted amongst their peers. They are able to adapt, depending on various situations. They accept their state of being and don't see it as being something negative. These children have successfully become self-actualized (for their age group)!

The only negative area that seems to be common for individuals with Cerebral Palsy is their athletic competence. Due to their lack of/inhibited motor skills, their ability to perform certain tasks or do certain activities becomes challenging, if not impossible. That is why training and individual exercise programs (exercise therapy, physical therapy, occupational therapy, etc.,) should be implemented. In doing this, educators and therapists can help increase mobility and possibly raise the way these individuals feel about their athletic capacities, as compared to their counterparts with no impairment.

Individual exercise programs will differ for each person with CP. Each person can have an array of different symptoms which can limit them in their capabilities. It is important that their personal needs are focused upon, methods that allow them to be able to progress physically. An example of this would be for a person with ataxia cerebral palsy. Since the person has an inability to coordinate their muscles, certain exercises may be difficult for him/her. There are different ways to modify different exercises, depending on the situation and condition. A great intervention for this problem would be adaptive aquatics.

In the water, people are a lot lighter so less stress is placed on their body. According to the Achievement Centers for Children (2009), adaptive aquatics are a great way to "build strength, increase cardiovascular endurance and improve motor planning skills." It is also a great way for children to move more freely than they would on land, due to less stress and weight on their body. Another outstanding example are programs involving Hippotherapy (the use of a horse as a tool to improve motor skills and coordination). It is well known that riders with disabilities improve significantly in functional skills (coordination, strength, posture, endurance, flexibility and more) following such therapy.

Thus, encouraging children (with CP) to exercise in individually modified situations enables them to view themselves as capable, even in an athletic capacity. A study by Melanie Ziebell (2009) and her co-workers focused on the relationship between physical activity and self-concept. They discovered (consistent with previously mentioned research) that students with CP scored low in athletic competence, but if they are included in athletic programs (like adapted aquatics, Hippotherapy, and others) they could see how their athletic abilities actually surpass those of their peers without disabilities.

In summary, self-concept is fundamental in any growing child and adolescent. It is a way that they view themselves, and it is also how they internalize how society views them. Despite some beliefs, those with intellectual and/or physical disabilities do not feel disadvantaged or have a low self-concept of themselves. Instead quite the opposite is true. They have relatively the same self-image and self-worth as do their peers who are not impaired. These children know they can achieve as much or more than their peers without disabilities, thus they may have a better sense of accomplishment. The only difference shown is in regard to athletic competence. However, research has shown that even athletic competence can be achieved (as the examples above have suggested).

Educators must continue to be a positive influence on all students, directly working to eliminate stereotyping and passing judgement before one truly gets to know the other person, and to see how capable they are. Stereotyping can have an extremely negative impact on everyone. It doesn't matter what race/ethnicity you are, it does not matter what gender you are, and it surely doesn't matter if you have a disability or not.

Research has shown that "stereotyped groups worry that their individual capacity will serve as a 'measure' for the abilities of everyone in their group, and the stress and self-doubt this produces demonstrably reduces their performance - creating the very outcome they were striving to avoid." (Conaway, 2005). If family members assume that their child is limited, then that child may feel limited and achieve only to a certain point, when in actuality, they can achieve so much more! Allow them to dream big, to reach for the stars, and many do just that; and quite often beyond the expectations of even those without disabilities!

REFERENCES

Biography: Altavia Evans is a native Floridian from Wellington, FL. She's currently a senior at the University of Florida, obtaining a degree of Science in Health Education and Behavior, as well as a minor in Family Youth and Community Sciences. After she graduates, Altavia plans to work at her local health department and volunteer with underrepresented populations. She enjoys cheer leading, cooking, and reading in her spare time.

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