What is cerebral palsy?
Cerebral palsy (CP) is a lifelong condition that affects movement and muscle control. It is caused when the brain is starved of oxygen either during the pregnancy or birth and the severity of the disability can be mild to significant.
There are several types of cerebral palsy:
- Spastic CP– can affect all four limbs, increases muscles tone, decreases range of movement, being stiff, awkward, and jerky movements
- Ataxic CP- affects balance, coordination and spatial awareness, difficulties with smooth movement, being clumsy and unsteady
- Dyskinetic CP- can affect the whole body, uncontrolled and involuntary muscle spasms, changes in muscle tone from stiff to floppy
The presentation of cerebral palsy varies from child to child, some will be able to walk and talk whilst those more severely affected will be unable to do these things. Learning difficulties, communication problems, epilepsy and swallowing difficulties are all common comorbidities.
Effects of cerebral palsy on toileting
Incontinence
The muscles used to control the bladder and bowel can also be affected by CP, meaning they are often in spasm or fluctuating in tone. Children may have limited ability to control them, leading to accidents. For some this will never improve, depending on the severity of their disability, however, a 2018 study[1] showed that 70% of children with CP gained control of their bladder and bowel functions but at a much older age compared to children without CP.
Urinary tract infections and constipation
When the bladder and bowel muscles spend a period in spasm and tightened, it becomes very difficult for the child to empty their bladder and bowel, leading to constipation and urinary tract infections.
Other cases of constipation in children with CP are- medications, lack of movement, limited water intake and poor diet due to feeding issues.
Understanding
Many children with CP also have some form of learning disability so may not be able to understand the concept or process of toileting and may need additional help to grasp the notion of toileting.
Introception is your internal signals letting you know what your body needs. For children with CP, it can be hard for them to interpret these signals as their brain may not receive or send the messages correctly.
Communication
Muscles in the mouth can also be affected by CP meaning many children have impaired speech and delayed motor control of their tongue. This can make it hard for them to alert someone when they need to use the bathroom.
Equipment
For many children with CP the physical element of toileting is the most complex.
Closomat offer a range of specialist wash and dry toilets, operable through various control options.* This means a child with limited gross motor and fine motor skills can toilet independently with dignity and respect. The toilet also has the option for a variety of supporting arms and toilet seats so can be bespoke to meet the needs of a child.
*Touch sensitive hand/foot switch; Proxy switch; Infrared remote control.
For children with more complex needs who require 24-hour postural management, a toilet seat that fits over the toilet may be needed. Closomat have specialist toileting seats with a wide variety of accessories to ensure the child has the correct postural support to be in an appropriate position for toileting.
Half Rifton (Clip-on).
A bottom wiper may be the answer for a child with adequate gross motor skills and understanding but limited fine motor skills as this removes the need to twist to wipe after using the toilet.
Need more help?
If you’d like further guidance around toileting for children with CP, check out Closomat’s other blog posts below. They will give you additional information as well as practical advice and tips to support a child with CP to develop independent toileting skills.
Toilet training for children with physical needs
Introspection – the impact on toileting
Occupational therapy tips for toilet training
Developing gross motor skills to assist with toilet transfers
- [1] Ramachandra, P., Figueroa, T.E. (2018). Toilet Training and Bladder Control in Children with Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O’Neil, M. (eds) Cerebral Palsy. Springer, Cham. available at Toilet Training and Bladder Control in Children with Cerebral Palsy | SpringerLink
